Treatment circle - Arm prosthesis

Our Treatment Circle shows you at a glance all the different steps involved in the fitting process for your orthotic device at the Ottobock Competence Centre. Here you find detailed information of what to expect of our services before, during and after your fitting.

The ultimate goal in all our Competence Centres is to restore your mobility, which includes increasing your level of independence and maximising your quality of life. In order to achieve this you will be supported by your interdisciplinary rehabilitation team consisting of doctors, therapists, prosthetists/orthotists as well as your family and friends. The whole process can take a couple of months depending on various factors amongst others your own motivation and participation.

1. Assessment

1. Assessment

A personal interview and thorough physical examination are carried out at the beginning of each fitting.

  • Initial examination before amputation

    Personal interview with your doctor

    Before your amputation surgery you have a personal interview and several thorough physical examinations with your doctor. Tests done there include blood analysis, X-ray of your lungs as well as checks of your heart and circulatory functions. Your doctor informs you in detail on what happens during and after the amputation and you have the opportunity to ask all questions relevant to you. Our advice is to take notes beforehand so you do not forget to ask anything that seems important. Nevertheless, you can still address follow-up questions since doctors are obliged to explain the processes and procedures to you even several times.

    In case of a traumatic accident you will naturally get the consultation with your doctor after the surgery. We as Ottobock want to get involved in the rehabilitation process as early as possible, so that our prosthetists can answer your questions and give you an impression of what to expect during the rehabilitation process. Furthermore, we are happy to cooperate with your doctors to achieve the best possible results for you. All you have to do is to call your local Ottobock Competence Centre prior to the surgery and we will arrange an appointment.

  • Psychological support

    We know that having an amputation is a major change in your life. However, you do not have to carry this burden alone. Your treatment team consisting of your doctor, prosthetist and therapist supports you in case of occurring problems and answers all your questions. Do not feel ashamed to talk about your fears – your treatment team is skilled to handle this situation and also offers psychological counselling. The earlier you seek support, the better, since overcoming mental conflicts and fears contribute to a rapid healing and regaining your quality of life.

  • Talking to other amputees

    Talking to other amputees has a positive influence

    Throughout our long history we experienced a positive impact resulting from dialogues between amputees. Talking to other amputees lets you get new insights on how other amputees deal with the situation. Moreover, you can get valuable advice on how to live with an arm prosthesis, the fitting process and how others handle their prostheses in everyday life. Your doctors, therapists and prosthetists help you to get in contact with local peer support groups.

  • Residual limb condition and assessment after amputation

    Immediately after the amputation the focus is laid on the healing of your residual limb so you can start therapy as soon as possible. It is likely that you will have a drain in your residual limb right after the amputation to drain fluids and blood out of the wound.

    To find the best prosthetic solution for you your prosthetist will conduct a personal interview and thorough physical examination in your local Ottobock Competence Centre. This is where your personal needs are being determined.

2. Therapy

2. Therapy

Therapeutic measures follow with the purpose of preparing you for a prosthetic fitting.

  • Oedema therapy

    Oedema therapy

    An initial swelling of the limb tissue after the amputation is expected. This is a normal, healthy reaction to the surgery and usually subsides after a few weeks. In the meantime, the wound needs to be dressed for your prosthetic arm fitting and the swelling needs to be reduced. This is done to prevent a pronounced residual limb oedema as it delays wound healing and it also takes longer for the residual limb to reach its final shape, so that the fitting of your arm prosthesis would be protracted. The oedema therapy and application of special creams ensure the scar tissue to remain soft and supple while simultaneously becoming resilient which is essential for wearing a prosthesis.

  • Compression therapy

    When the wound dressing or residual limb plaster is removed, compression dressings are applied using a special bandaging technique. This promotes the circulation in your residual limb, reduces pain and helps to improve the healing of the scar as well as the shaping of the residual limb. In the first few days and weeks after the surgery, your residual limb is bandaged by your therapist or nursing staff. This somewhat elaborate compression with elastic bandages has the advantage that the dressing can be individually adapted to your residual limb and amputation level. Later the nursing staff or your doctors can show you how to put the compression bandage on yourself. You have to wear the compression dressing all the time until the residual limb heals. As soon as everything is healed, you can try to sleep one night without the dressing after consulting your doctor, prosthetist or therapist. If the residual limb exhibits pronounced swelling again the next morning, compression therapy has to be continued.

    Next to elastic bandages, silicone liners are another compression option. Silicone liners are available in standard sizes but can also be custom-made. The liner exerts even pressure on your residual limb, bringing it into the correct shape, while the elastic, skin-friendly silicone makes the scar soft and supple. Your prosthetist will give you further information on how to correctly wear and clean your silicone liner.

  • Correct positioning

    Correct positioning after the amputation surgery helps to prevent your muscles and joints from shortening or stiffening

    Immediately after the surgery nursing staff will assist you to shift your position several times a day to prevent bedsores and help you to find a position free of pain. Your positioning in bed should be done in such a way that the muscles and joint closest to the residual limb do not shorten or stiffen. How to correctly position your residual limb will be shown to you by your doctor or therapist.

  • Targeted preparation for your fitting

    In your Ottobock Competence Centre you will receive a targeted preparation for your fitting

    Starting with the therapy is a critical step towards regaining your independency. Your team consisting of prosthetists, doctors and therapists creates a tailor-made therapy programme for you. We advise you to start therapy as soon as possible after the surgery to strengthen your muscles. This will make your time during rehabilitation much easier. Your doctor or therapist will show you therapy exercises to optimally prepare you for your prosthetic fitting.

  • Muscular training

    Stretching the residual limb musculature as a preparation for wearing an arm prosthesis

    The muscular training functions as a preparation for your muscles to wear an arm prosthesis. The amputation of an arm causes a loss of weight on the amputated side which can lead to imbalance and poor posture. It is important to pay special attention to keeping your torso in balance and maintaining a healthy back. Keeping that in mind special exercises can help to prevent the development of any malposition. To maintain the flexibility of your remaining joints the residual limb should also be included in the training. Your therapist will show you the exact exercises to train your torso, back, shoulder and residual limb. Your active participation is crucial for a successful fitting.

  • Improving the dexterity of your sound side

    Improving the dexterity of your sound side to prepare you optimally for your arm prosthesis fitting

    Training of the sound side follows, depending on whether your dominant hand or the opposite hand was affected. Fine motor skills, dexterity and strength training will be practised. The more capable you are with your sound hand, the better you’ll be able to perform activities of daily living and take care of yourself. It’s important to practise challenging activities such as writing or brushing your teeth early on.

3. Fitting recommendation

3. Fitting recommendation

This is where you learn which prothesis is most suitable for you and which personal objectives should be pursued.

  • Advice

    Your prosthetist helps you in finding the best possible arm prosthesis for your individual case

    Your prosthetist at the Ottobock Competence Centre considers all the factors that influence the selection of a suitable arm prosthesis for you. These include your physical condition and health, the amputation level, your motivation and the demands you place on the prosthesis as well as your professional and private environment. The options offered to you by Ottobock’s modern prostheses meet all the requirements of daily life. Your prosthetist helps you to choose the best prosthetic components individually for you. Generally your arm prosthesis fulfils the function of restoring your quality of life, preventing posture problems as well as balance impairments and helps to avoid excessive strain of your sound arm.

4. Measurement

4. Measurement

The prosthetist takes your individual body measurements.

  • Importance of correct measurements

    The prosthetist takes your individual body measurements

    For us at Ottobock regaining your mobility means you can rely on the support of your arm prosthesis in all your daily activities. You need to be able to control the prosthesis during each movement phase to fully benefit from its functions and to enjoy smooth movement patterns. Therefore, the component connecting your residual limb with the arm prosthesis, known as a socket, needs to fit you perfectly. This is why we use full-contact sockets that give you more control and result in a better functioning of the whole prosthesis. To ensure the correct fit of the socket as well as the whole arm prosthesis it is essential to take detailed measurements of your residual limb and body. This is why Ottobock constantly develops new improved measurement methods which are used in our Competence Centres worldwide. Depending on the condition of your residual limb we employ digitally based methods or use plaster cast to take your individual body measures as precisely as possible.

5. Production

5. Production

Fabrication of your custom prosthesis follows.

  • Custom-made process

    Production of your custom arm prosthesis

    Using your individual measurements your prosthetist produces a one-to-one model of your residual limb which is the basis for manufacturing a thermoplastic interim socket. After having determined all prosthetic components your prosthetist assembles a complete artificial arm and aligns it accordingly.

6. Fitting

6. Fitting

During the fitting, the prosthetist adapts the prosthesis to your individual needs.

  • Interim arm prosthesis

    Interim arm prosthesis

    Your prosthetist will decide whether an interim arm prosthesis is necessary in your case based on your individual needs, wishes and the condition of your residual limb. Due to the fact, that the interim socket, also called test socket is made from a thermoplastic material it allows your prosthetist to react to volume fluctuations in your residual limb and to make sure the socket is perfectly comfortable for you. You will wear the interim prosthesis for early training exercises such as opening and closing your hand. The interim prosthesis consists of all the parts that your final arm prosthesis comprises of – the prosthetic hand, the wrist joint, the elbow joint where applicable and the socket. You may need to visit your local Ottobock Competence Centre several times for adjustments to be implemented. We know that this might be perceived as a tedious process, nevertheless be patient in this stage of your fitting as it determines the perfect fit of your final arm prosthesis. After no more volume fluctuations occur in your residual limb the suitability of the prosthetic components as well as your interim socket is evaluated. When everything is to your satisfaction your final arm prosthesis will be manufactured.

  • Final arm prosthesis

    Final myoelectric arm prosthesis

    When a comfortable fit of your socket has been achieved after several trial fittings and all prosthetic components have been selected carefully your final arm prosthesis can be assembled. The prosthetic alignment process can vary from patient to patient depending on your body posture and physique. Be assured that your prosthetist advises you on the best prosthetic solution for you. Once your final arm prosthesis is ready additional trial fittings with your prosthetist follow to check the prosthetic alignment and to precisely adapt the prosthesis to your needs. At this stage your prosthesis can also be equipped with a custom-made aesthetic cover.

7. Rehabilitation

7. Rehabilitation

Here you learn how to correctly handle the prosthesis in daily life.

  • The rehabilitation process

    During rehabilitation you learn how to use your arm prosthesis confidently

    To ensure an optimal synergy between the prosthetic technology used and our therapeutic expertise a therapist will accompany you during your rehabilitation process in your Ottobock Competence Centre. Nevertheless, most of your rehabilitation programme will take place in a specialised clinic. Therefore, we would like to have as much contact with the clinic as possible to support you during your rehabilitation. The purpose of your rehabilitation is for you to train wearing your arm prosthesis with the ultimate goal to provide you with maximum independence and quality of life.

    The starting point of your rehabilitation training depends on the condition of your residual limb. The rehabilitation phase begins when the wound on your residual limb has healed properly which can take up to 6 months after the amputation. Depending on your individual circumstances the training will be done with your interim or final arm prosthesis. You can directly influence the success of your rehabilitation through active participation as well as high levels of motivation and self-confidence.

  • Care of your residual limb

    In rehabilitation you learn how to correctly care for your residual limb

    During rehabilitation you learn how to care for your residual limb and scar yourself. Your therapists will guide you and provide you with valuable advice. To prevent rough and scaly skin you should wash your limb with mild soap (e.g. Derma Clean) twice a day. The skin should then be dabbed dry thoroughly and a special cream should be applied that is designed to care for highly stressed skin. We recommend you to use Derma Prevent and Derma Repair to avoid chafing of the skin and to keep it soft and supple. Putting on your arm prosthesis right after washing your limb might be a bit difficult since warm water causes the limb to swell slightly. In order to prevent infections you should pay special attention to folds of your skin and scar contractions. Look out for skin injuries, pressure points and blisters which require medical treatment. To see the back side of your residual limb more comfortably you can make use of a mirror. The flexibility of the scar can be enhanced by gently stretching and massaging it.

  • Caring for your arm prosthesis

    Cleaning your arm prosthesis daily with mild soap and water helps to prevent skin infections and irritation

    Clean the inside of the socket with a moist cloth to remove sweat residue and skin particles daily. This helps you to avoid skin irritation. If you wear a liner, please care for it daily according to the user manual. Finally, if you have a myoelectric system, you’ll likely have to charge the batteries on a daily basis.

  • Correct donning and doffing

    During rehabilitation your prosthetist will show you the best way to put your arm prosthesis on

    During rehabilitation you will also learn how to correctly put your arm prosthesis on (donning) and take it off (doffing). There are various ways to don a prosthesis depending on the prosthesis itself and on the characteristics of your residual limb. Taking your individual circumstance into consideration your therapist will show you the best solution for you to handle your arm prosthesis confidently. Initially, your family or friends may need to help you, but the goal is for you to ultimately be able to do this on your own.

  • Controls training

    Learning how to open and close your prosthetic hand during controls training

    The goal of rehabilitation training with a therapist is to help you gain as much mobility and independence as possible. Depending on the components used in your arm prosthesis controls training will teach you how to open and close your terminal device or hand, rotate it internally and externally and in case of higher level amputations how to flex or extend the elbow and shoulder. Think of controls training as learning about all the controls for driving a car – without really driving yet.

  • Repetitive drills training

    Repeating specific movements helps you to control your arm prosthesis more easily

    Repetitive drills training on the other hand is where you learn to ‘drive the car’ by repeating specific movement patterns. The more you practise the better you’ll get at remaining relaxed while performing the movements and the more automated the movements will become. With enough repetition you’ll be able to simply make a movement instead of thinking about it.

  • Activities of daily living (ADL) training

    Learning how to pour a drink with an arm prosthesis as part of the activities of daily living (ADL) training

    After the repetitive drills, you are ready for more complex movements that you’ll encounter in everyday life. Your therapist tailors the ADL training to your personal goals and needs, depending on your day-to-day life and occupation. You begin with simpler activities such as folding a towel, and then work your way up to things such as preparing a complete meal and eating it with a knife and fork. ADL training also includes getting dressed and undressed, opening a bottle and pouring a drink as well as using a computer and office tools.

  • Assistive device consulting

    Using assistive devices to increase your independence with your arm prosthesis

    If you experience difficulties with your new arm prosthesis while performing certain activities, various assistive devices may be used to increase your independence. Your therapist can determine whether this is an option for you. However, the less is more rule applies to all devices. The fewer devices you need, the greater your day-to-day independence. If you use many specialized devices in your home environment, it will be more difficult to handle situations outside your home without those devices.

8. Quality check

8. Quality check

Together with the rehabilitation team you discuss to which extent you can cope with the prosthesis.

  • Final adjustments

    Final adjustments of your arm prosthesis with your doctor, prosthetist and therapist

    A team consisting of your therapist, prosthetist and ideally your doctor will finally approve your arm prosthesis implementing final adjustments and recording your progress. Before you leave you will be handed a treatment outcome report for your documentation as well as a user manual for your prosthesis including all important information on how to use your arm prosthesis in everyday life.

9. Follow-up

9. Follow-up

The Ottobock Competence Centre maintains continuous contact with you.

  • Stay in touch

    The Ottobock Competence Centre maintains continuous contact with you

    Ottobock regards itself as a long-term partner for you to master the challenges that you decide to tackle. This is why, even after your successful fitting, adjustment period and rehabilitation your local Ottobock Competence Centre still remains in contact with you. We recommend you to visit us for regular check-ups so we can determine if adjustments need to be made and can implement these.

    Please feel free to get in touch with us in case you have questions or queries of any kind.

1. Assessment