Upper Limb Rehabilitation

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The following upper limb resources and links are recommended by the handsmart group.

General information

The sudden loss of a hand or arm has a heavy impact on a person’s life. To compensate the lost motor functions, tactile sensation, proprioceptive feedback, and aesthetic appearance to some extent three types of prostheses are currently available. While passive prostheses mimic the look and weight of a hand, body-powered and myo-electric devices can provide the user with active grip function.

We recommend the following resources to get an overview of amputation management and prosthetic training:

Children

Children are resilient and are capable of learning how to manage tasks in their daily lives whether they are born with limbs intact or with limb differences. Treatment options for children with limb differences vary depending on the child’s anatomy, their family situation, the physical and social environment in which they live.

The rehabilitation goal for children with limb differences is to enable them to live as any other child would. They should be able to participate in the same activities at the same level as their peers. There should be no restrictions related to the limb difference. This may be accomplished through use of a prosthesis, adaptations to the environment (i.e. specific equipment), or adapted methods of performance.

If the child is fitted with a prosthesis at an early age, encouraged to wear it and taught how to use it, they will learn how to use it to accomplish important activities using the prosthesis. If a child chooses not to use a prosthesis, he or she will learn to do important activities in other ways, usually using the residual limb or other body parts to compensate for the missing limb.

Whether a child uses a prosthesis or not, it is important that they be followed throughout their childhood to ensure they continue to meet expected developmental milestones and that they receive training and support to encourage independence in their activities of daily living. The child’s needs will change as they enter different stages of life through childhood into adolescence and then into adulthood. It is important to reassess the child at these transition periods to ensure that the individual has the skills and support to assure independence at each stage of life. At these times, treatment options should be reconsidered, as a particular type of prosthesis or adaptive equipment may be requested. Psychosocial issues must also be considered.

Pain

Introduction

Different types of pain are frequently reported after acquired upper limb amputation. Acute post-surgery pain is recognized and treated in the surgical ward, and is not discussed here. Chronic amputation-specific pain is divided into phantom limb pain (perceived in the amputated limb) and residual limb pain (located in the amputation stump). Amputation neuromas (small, benign nerve tumors occurring after nerve injury) may cause residual limb pain and/or enhance phantom limb pain. Persons with upper limb loss (acquired and congenital) also often experience musculoskeletal pain and overuse complaints. In acquired upper limb amputees, as many as 9/10 report at least one pain type (phantom, stump or musculoskeletal), and symptomatic neuromas are found in up to 1/3. Pain and overuse complaints may affect both physical function, prosthesis use and the quality of life. Prevention and treatment of pain is therefore relevant in all phases of rehabilitation after upper limb loss. The treatment options and preventive measures are dependent on the type of pain.

Phantom limb pain (PLP)

Although 50-80% of amputees experience phantom limb pain, treatment strategies with high enduring positive effects are yet to be developed.

Phantom limb pain is often considered neuropathic because of associated neuronal changes in the central and peripheral nervous systems. Hence, pharmacologic interventions have traditionally been based on guidelines for neuropathic pain. The effect on PLP is for most drugs however not well documented, and for some agents the effect on PLP differs from the effect on other types of neuropathic pain. Furthermore, most standard drug therapies provide pain reduction to a very limited extent and prove ineffective in a subset of patients.

Current best evidence suggests that paracetamol and NSAIDs should be tried before other pharmacologic agents. If paracetamol and NSAIDs do not give sufficient pain relief, the SNRI duloxetine (Duloxetine, Cymbalta) should be tried before gabapentin (Neurontin), then pregabalin (Lyrica) if these medications do not give sufficient pain relief. The evidence for the effect of duloxetine on phantom pain is of the same quality as for gabapentin and pregabalin, and these are all suggested as first line agents for other neuropathic pain. However, duloxetine has the advantage of not needing a time-consuming gradually dose increase, and also, existing evidence suggest that the side effects for the most common dose (60 mg) is on the placebo level. For gabapentin and pregabalin, side effects are relatively common, and these may cause the patient to reject the medication before reaching the therapeutic dose. The next pharmacologic agents suggested are topical lidocaine (Xylocaine, Lignocaine) and topical capsaicin (Qutenza, Capsina). The recommended second line medication in general has less convincing evidence than the first line agents. Also, side effects are common. In this category, we find oral morphine, transdermal buprenorphine, tramadol (Ultram, Ralivia, Tramal) and the tricyclic antidepressants (TCAs).

Psychological interventions are on the rise, but have so far not been found to improve pain and subsequent quality of life on a long-term basis. Some of these interventions are nevertheless suggested treatment options for PLP based on an overall assessment of clinical experience and research evidence.
Current best evidence suggests that mirror therapy is beneficial in a subset of patients, in clinical experience especially those who experience a clenched phantom fist or other forms of painful awkward positioning of the phantom. No harmful side effects have been reported, and the treatment is low-cost and relatively easy to perform (although it is still unclear what the optimal treatment protocol is). Therefore, mirror therapy can be recommended to treat PLP. The treatment should be initiated by an experienced therapist.

There is some weak positive evidence that the use of active (myoelectric) prostheses may reduce phantom limb pain. The effect is explained by the “principle of functional salience” – i.e. that stump stimulation in a functional context may positively modify cortical reorganization and the perception of PLP. This might also apply for body-powered prostheses, however this has not to date been studied. Current evidence does not support recommending active prosthesis use as pain treatment, but it does support informing upper limb amputees that PLP is not a contraindication for prosthesis use and that in some cases, the pain might even improve.

The evidence for the effect of transcutaneous electrical nerve stimulation (TENS) on PLP is promising, but weak. However, this non-invasive treatment option has few side effects, is relatively easy to apply and can be combined with other pain treatment. TENS can therefore be recommended to treat PLP. The treatment should be initiated by an experienced therapist. Hypnosis and cognitive behavioral therapy are well documented interventions for other pain types, but lack evidence for long-term effect on PLP. These interventions may however be helpful for some patients and can be tried if other treatment options fail to give sufficient pain relief. New behavioral treatment strategies including biofeedback training, Graded Motor Imagery and virtual reality are promising, but have to be studied closer in randomized controlled trials with long-term follow-up to prove their efficacy and allow translation into routine clinical practice.

Invasive treatment options like acupuncture, injections of botulinum toxin type A (BoNT-A) and steroids, different nerve blocks and denervation have only low quality evidence and may have serious side effects. They are therefore not suggested for PLP treatment.

Residual limb pain


First, it is important to rule out mechanical reasons for pain, such as suboptimal fit of the prosthesis socket and insufficient soft tissue coverage, and pain related to ulcers, scars and infection. Neuromas may cause residual limb pain, and should always be considered. Furthermore, it is important to distinguish between actual stump pain and radiating or referred pain from other locations (e.g. neck, shoulder, trigger points in corresponding musculature, heart disease and rheumatologic disease).

Clinical experience suggests that desensitization of the residual limb by gentle massage and tapping / tactile stimulation may reduce stump pain and contribute to the amputee better adjusting to the new body image. This simple measure should therefore – despite lack of research evidence – be recommended for all acquired upper limb amputees.

Upper limb amputees often experience both residual limb pain and phantom limb pain, and several studies of the relevant pharmacologic and non-pharmacologic treatment options include both types of pain. Therefore, some of the same treatment options as for PLP may be considered for chronic stump pain. This includes several of the pharmacologic interventions discussed above (paracetamol, NSAIDs, topical lidocaine, topical capsaicin, oral morphine, transdermal buprenorphine, tramadol and the tricyclic antidepressants), TENS, hypnosis and cognitive behavioral therapy. For mirror therapy an effect on residual limb pain is not documented, and this treatment option should therefore be reserved for PLP. As for PLP, the new behavioral treatment strategies such as biofeedback training, Graded Motor Imagery and virtual reality need to be studied closer before being recommended for use in routine clinical practice, and the invasive treatment options acupuncture, BoNT-A, steroid injections, different nerve blocks and denervation are not suggested for the treatment of stump pain based on lack of evidence and the risk of serious side effects.

Neuroma pain


In prosthesis users, it is common clinical practice first to adjust the prosthesis socket to relieve any mechanical pressure on the neuroma. For other treatment options, current evidence is inconsistent, and there is no clear consensus on the optimal treatment of neuroma pain. Measures that can be tried are TENS and different oral and topical pharmacologic treatment (with NSAIDs as first choice, then as for PLP). Surgical removing of the neuroma should be considered if conservative measures do not provide adequate pain control, especially for neuromas exposed to mechanical stimuli. The results after neuroma surgery however suggest that only about 1/3 of patients with amputation neuroma experience postoperative pain relief, and that some even experience worse pain after surgery. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) are promising surgical techniques that may prevent neuroma formation and -pain, but these are to date not available in routine clinical practice.

Musculoskeletal pain and overuse complaints


A population-based study of Norwegian acquired major upper limb amputees found that these patients have 2,6 (neck/upper back) to 4 (shoulder) times more musculoskeletal pain than the general population. It is assumed that this may be due to altered biomechanical task performance after the amputation, where the amputee compensates for lost grip, length of reach and motion in the amputated joints by compensatory movements and excessive motion at other articulations. The resulting changed kinematics of the shoulder, shoulder girdle or torso may lead to musculoskeletal dysfunction and increased risk of musculoskeletal pain. Furthermore, although the residual limb may be used for tasks such as fixing and lifting objects, unilateral limb loss will naturally be followed by a transfer of that hand/arm’s function to the other arm, increasing the workload of this arm and hence the risk of overuse complaints. Therefore, all persons with upper-limb loss (acquired and congenital) should be given advice on how to prevent musculoskeletal pain and overuse complaints.

The level of limb loss and individual factors such as age, profession, leisure interests and comorbidity (other illnesses) will determine the specific details of the advices given. All persons with upper-limb loss should however be advised to strive for symmetry in practical task performance. They should also be advised to use prostheses, other aids or ergonomically expedient alternative techniques when possible, to relieve strain on the non-amputated side and thus reduce the risk of overuse complaints. Prosthesis use per se has however not been shown to prevent musculoskeletal pain in persons with upper-limb loss – perhaps partly due to varying and broad definitions of use in the studies conducted, and the lack of large, longitudinal studies. Based on general principles of training and tolerance to repetitive strain, persons with upper limb loss should also be advised to perform basic muscle strength training. Physiotherapy guidance may be useful, but is not always necessary.

There is no evidence that existing musculoskeletal pain and overuse syndromes should be treated differently in persons with upper-limb loss than in persons with two intact arms and hands.

Further information:

If you would like to learn more about this topic, you may wish to have a look at the following scientific publications:

This insight into pain and pain treatment was provided by Kristin Østlie, MD, PhD based on her vast experience in clinical and scientific work with people with upper limb loss or absence. We would like to thank her for this contribution. If you have any questions or comments regarding this article, please feel free to contact us at info@handsmartgroup.com.

Some more general information on pain and pain treatment can be found on www.retrainpain.org.

Prosthetics

Overview of Upper Limb Prosthetics

This section will cover an international perspective and discussion surrounding the rehabilitation and treatment of children and adults with upper limb differences. There are various factors to ensure successful outcomes in upper limb rehabilitation.

Congenital and acquired limb absence

Clients may present with congenital or acquired limb absences ie. below elbow absence, absences above the elbow, at the shoulder level, and those with partial hands. Amputations that are acquired usually occur due to diseases such as tumors or due to accidents.

Process of Prosthetic Treatment/Intervention

Initial Consultation/Assessment

Physical, developmental and functional assessments are carried out by a multi-disciplinary team including therapists, prosthetists, physicians, etc., focussing on their abilities with recommendations to reflect the client’s goals, including prosthetic treatment. Some of the important aspects of the initial evaluation including cause of limb absence, hand dominance, range of motion status of opposite extremity, phantom and residual limb pain, possible myoelectirc sites, goals and expectations.

Pre-prosthetic training/Post-surgery therapy

This stage is important to prepare the residual limb for future use of a prosthesis. Pre-prosthetic preparation includes: shaping and shrinking of the residual limb, desensitization, maintaining ROM, maintaining skin mobility, increasing muscle strength, maximizing functional independence, orientation to adaptive equipment, change of dominance if necessary, determining myoelectric sites and strengthening, exploring and orienting client to appropriate future goals with prosthesis.

Selection of components

Dependent upon the goals identified at the initial evaluation, appropriate components should be comprehensively discussed.  The unique differences between body-powered and powered components should be described, and examples of each should be shown and demonstrated if possible. An overview of the advantages and disadvantages of each should be clearly explained.

Interface/Socket design

After assessment and evaluation, an appropriate interface or socket is designed that will be customized to provide adequate suspension, comfort and to support the components of the prosthesis.

Evaluation/EMG testing

Control strategies are chosen after muscle testing is completed. The muscle belly is palpated and an electrode is placed along the muscle fibers, as the muscle belly provides the strongest signal. Good skin contact and constant electrode pressure along with well calibrated electrode sensitivity ensures good control of the prosthesis.  Software with virtual controls training provides visual feedback of EMG signals, biofeedback, and trains clients how to perform repeatable, consistent signals.

Shape Capturing/Casting

The shape of the residual limb is captured in different ways by the prosthetist ie. plaster bandages, silicone impressions or scanning the limb. This can be completed once appropriate electrode sites are chosen. Bony landmarks are identified and the electrode sites are marked and transferred to the socket/diagnostic interface.

Diagnostic interface or socket check

After assessment and evaluation, an appropriate interface or socket is designed that will be customized to provide suspension, comfort and to support the components of the prosthesis. A diagnostic interface or test socket is used to evaluate pressure points or sensitive areas and can be adjusted or modified for comfort. A variety of materials can be used in the design of an interface or socket including laminates, such as acrylic resins, thermoplastics or silicone.

Provision of prostheses or adaptive aids

A prosthesis is provided to the client that will meet their goals. Proper technique in putting on and taking off (donning & doffing) of the prosthesis is practiced, and proper socket fit and electrode placement is reinforced. The team ensures that the client has good ROM, and is able to control the prosthesis in different activities. Other important components of this process include; orientation to a gradual wearing program, checking the skin for good electrode contact, educating the client and family about battery charging, instruction in proper hygiene of the residual limb, as well as an orientation to cleaning and maintaining their prosthesis. Adaptive aids may be provided at this time as well.

Functional Evaluation/Training

To ensure successful use of the prosthesis and integration of the prosthesis into meaningful daily activities, experienced prosthetic training is required. The progression of functional training includes controls practice, basic grasp and release of items, and a progression from simple to more complex unilateral and bilateral tasks. The emphasis should be on two-handed (bilateral) tasks where the prosthesis is utilized as a functional assist. The calibration of the electrodes is assessed as the client performs functional training with two-handed (bilateral) activities. For example, if a client is frequently dropping items, the sensitivity for the open electrode can be adjusted accordingly. This can be initially performed in conjunction with the prosthetist to assure proper calibration.

Outcome Measures

The clinical team uses multiple outcome measures to track progress over time. Using a combination of assessments that capture the client’s goals, functional use and quality of life provides the team with a holistic picture of how the client is performing with their prosthesis and how useful they find it in achieving their goals.

Follow-up

The team schedules follow-up appointments according to the client’s needs, monitors physiological changes and modifies the treatment plan accordingly.  During follow-up, the team monitors the client’s physical status and monitors the client’s activity interests over the course of their lifespan. The team determines if the client’s current prosthetic device is meeting their needs or if different prosthetic components are available that could enhance the performance of their daily activities.

Types of Prostheses

Please refer to the Manufacturers web sites in the Manufacturer Section for a more detailed explanation of these prosthetic devices.

Passive

A passive prosthesis can also be referred to as a “passive functional prosthesis” or “aesthetic restoration”. The “function” of a passive hand is demonstrated when it acts as an assist to the sound hand in certain functional activities such as holding items down or supporting the weight of heavy objects when using both arms. Passive hands are available with internal wires that can pre-position the fingers.

Body-powered

A conventional, or standard, upper limb prosthesis is known as a body-powered prosthesis. The shoulder and/or arm movement operates the terminal device, and /or elbow, by means of a shoulder harness and cable.

Externally powered prosthesis

In the late 1950’s and early 1960’s the use of external power was introduced as another option to control upper limb prostheses. An externally powered prosthesis has a motor with batteries and is operated by an electromyographic (EMG) signal, linear transducers or by control switches. It provides a more self-contained prosthesis, is more pleasing in appearance and less encumbered by the shoulder harness. The standard control system uses 2 muscles (generally agonist and antagonist). Myoelectric control is also possible with only 1 signal but limits the functionality und usability. Various myoelectric hand prostheses are available on the market. They differ in functionality, grip patterns, size, appearance and control.

Hybrid Prosthesis

For levels such as a transhumeral or shoulder disarticulation, complete electric prostheses, or complete body-powered prostheses do not always meet the functional needs of the client.  The added weight of a total externally powered prosthesis is often contraindicated as well. Additionally, myoelectric sites may not be available for a totally electric prosthesis. In these instances, a hybrid design that combines a body-powered component with an electric component is a preferred alternative. The most common hybrid design combines a body-powered elbow and an electric hand or electric terminal device (ETD)/ aka electric hook.

Activity Specific Prosthesis

Individuals missing a hand or parts of an arm often have sufficient strength, motivation and talent to be successful in a sport, recreational pursuit, or work-related activity, but they lack the ability to participate. A specialized prosthetic accessory, or modified sports equipment, will allow them to participate.  Successful participation in a favorite sport, or work related activity, can often be the key to unlocking an individual’s overall well-being and functional independence.

DISCLAIMER: The below manufacturers are listed in alphabetical order and the company description is taken from their website. This page is meant as a place to list all upper limb prosthetic manufacturers in one area and is not to be considered an endorsement. We cannot guarantee the correctness or completeness of this information. Please contact us, if you feel that a company is missing in this list.

Coapt

Coapt was founded on focused and dedicated research to deliver modern myoelectric control for the benefit of users and clinicians alike. Our mission is to use our strong clinical research background, portfolio of transformative technologies and reputation for innovation and clinical implementation to develop, market and distribute products that will improve the quality of life for prosthesis users.

College Park Industries

Our passion is centered on technology, innovation, and the creation of new benchmarks that restore maximum function for amputees of all ages and activity levels. We take pride in bringing advances in prosthetic design to our customers and end-users, such as Intelliweave® composites, Enviroshells™ and iST™ (Integrated Spring Technology). Unlike other manufacturers, our products are custom-built for each individual patient based on their unique specifications, and we do not pull a product off the shelf. We are ISO 13485 certified with an extensive focus on quality testing, and source and produce all products in the USA. With precise engineering and quality manufacturing, College Park is committed to innovating human locomotion solutions for users all over the world.

Fillauer Companies, Inc.

Fillauer Companies, Inc. has grown to be a globally renowned leader in the development, manufacturing, distribution and application of orthotic and prosthetic products.  Fillauer Companies, Inc., is comprised of upper limb subsidiaries, Hosmer and Motion Control.

  • Hosmer

The Hosmer Dorrance Corporation began in 1912 when D.W. Dorrance, an amputee, invented the first split hook out of dissatisfaction with the terminal devices available at the time. Thanks to his inventive nature, he continued to solve problems he and other amputees faced, establishing Hosmer as a well-respected leader in the orthotics and prosthetics industry. Beginning with simple improvements and electrical devices, Hosmer led the industry in myoelectric components and technology. In 1996, Hosmer joined the Fillauer Companies, Inc. in a concerted effort to meet the needs of their growing customer base with as many products and options as possible. Hosmer’s product line includes upper and lower extremity orthotic and prosthetic products with a specialty in hands and knees.

  • Motion Control

In 1974, a group of faculty members and researchers at the University of Utah in Salt Lake City joined forces to commercialize the medical technology developed at the University’s Center for Engineering Design. The result was the world’s most advanced prosthetic arm, the Utah Artificial Arm, and the creation of Motion Control. The Utah Arm was upgraded in 1997 to create the U2, and further upgraded in 2004 to create the U3. Microprocessors control the elbow and hand allowing the wearer to control them simultaneously. One of many technically advanced products created by Motion Control, the U3 sets the standard for all their prosthetics: a combination of superior performance, technology, and cosmetic appearance. Motion Control, Inc. is the leading U.S. manufacturer of myoelectric and externally powered prosthetic arm systems. Motion Control joined the Fillauer Companies, Inc. in 1997. They offer world-class prosthetic technology and a team of professionals working daily to make their technology even better.

Infinite Biomedical Technologies (IBT)

IBT’s mission is to improve the lives of amputees through the development of meaningful devices.  Today, IBT is a tightly focused group of engineers, students, and researchers working together to improve the lives of upper limb amputees through the development of devices that matter.  Working closely with patients and clinicians, we are building technology that will make prostheses more dependable, functional, and comfortable.  We’re proud to be innovating technology that will help people work, play, and live their lives.

Naked

Naked Prosthetics designs and manufactures high-quality prosthetic devices specifically for finger loss. Our mission is to assist people with digit amputation(s) and positively impact their lives with fully articulating high-quality custom finger prostheses. Our product aims to restore the ability to perform most tasks, supporting job retention and an active lifestyle. Our customers have lost fingers to power tools, equipment malfunctions, injury in the line of military service, random accidents, and infections; in some cases, multiple digits have been lost. Historically, finger prosthetics have been considered a second tier of prosthetics due to the lack of meaningful functionality. NP now provides a viable functional prosthesis, versus a passive cosmetic solution. Our design mimics finger motion and utilizes the remainder of an amputee’s digit to power the device.

Ossur

Pioneers of advanced technology, our mission is to improve people’s mobility. As a global leader in non-invasive orthopaedics, we have nurtured an innovative mind-set, continuously pushing the boundaries to create the best products and services in the fields of Prosthetic, Osteoarthritis and Injury Solutions. True advocates of “Life Without Limitations”, we work with individuals, clinicians and diverse communities around the world to support a better quality of life for millions of people.

Ottobock

Since its founding in Berlin in 1919, Ottobock has pursued a vision: to improve the mobility of people with disabilities through innovative products. In doing so, the company equates quality with “Quality for life”: the quality of life enjoyed by the people who use Ottobock products every day. People at the center, their individuality and requirements and needs with respect to functionality, quality as well as design form the basis for the company’s enduring capability of innovation.

All around the world, the Ottobock name stands for high-quality and technologically outstanding products and services. The goal of helping to restore mobility for people—or protect what mobility they have—stands behind each and every Ottobock product. The conviction that quality of life is closely associated with a maximum of individual freedom and independence is a key concept that has been a major influence throughout the company’s 90-year history.

Partial Hand Solutions

Partial Hand Solutions is an innovative company dedicated to advancing technology for partial hand amputees.  Since the companies inception in 2007, Partial Hand Solutions has provided functional solutions for many active soldiers and individuals with partial hand and partial finger amputations.  Partial Hand Solutions prosthetic fingers are the first of its kind that can offer a functional option for those individuals.  The M-Fingers, Partial M-Fingers and M-Thumb have allowed these individuals to maximize their potential and enhance their overall functional outcome.  The new TITAN series prosthetic fingers are now available and designed to meet the demands of the heavy duty user and highly active individuals.

Point Designs, LLC

Durable full finger prostheses for partial hand amputees. Website currently states it is under development.

TASKA Prosthetics

TASKA™ was engineered to do one thing – to be more useful than any other myoelectric hand available. It frees you to do more. More of the big little things like peeling a potato, clicking a computer mouse, doing the laundry, washing the car, mowing the lawns or firmly holding a knife to cut a thick juicy steak. Daily tasks now come easily without the need to be forever changing grips or having to wear a glove. We hope you will be as excited as we are about this advanced, robust and waterproof prosthetic hand. Together with your Clinician and TASKA™ team, you will be fully supported in making the most of the practical tasks it now makes possible for the first time.

Texas Assistive Devices (TAD)

Texas Assistive Devices originally developed the Hayden Preston System (HPS). It was the only interchangeable prosthetic tool system in the world at the time that featured a terminal device with a pitch adjustment of 60° including 360° rotation. The universal push-button quick insert-release terminal device was capable of utilizing a wide selection of custom designed and crafted interchangeable tools and implements. Because of the HPS’s unique design, it allowed the user to perform jobs, chores and duties that he or she would be unable to do otherwise without an assistant. The HPS System offers N-Abler products including wrist adapters, hands free tool changing station and the body powered five function wrist, which allows for wrist flexion, extension, pronation, and supination. Texas Assistive Device’s mission is to become the world’s leading provider of devices designed to assist persons with upper extremity amputation and hand dysfunction.

TRS

TRS Inc. was formed in 1979, by upper limb amputee Bob Radocy, who was frustrated by the limited performance of commercially available prosthetics devices. He lost his left hand about four inches below the elbow in an auto accident in 1971. Bob experimented with all types of prosthetic devices. In 1977, while in graduate school, he applied his engineering and biological sciences education and design experience to create a high performance, prehensor which allowed him to be competitive with two handed peers in any activity he chose. Thus in 1980, the GRIP prehensile hand was first manufactured.

Since then, TRS has grown to become the leading innovator of body-powered prosthetic devices in the world. TRS remains specialized. We design and build only high quality technology for persons missing a hand(s). Please use TRS as your personal information resource in upper limb prosthetic technology. We are here to help you! TRS Products are available through all certified prosthetic and orthotic facilities in the USA and via specific prosthetic resources worldwide. Please contact TRS directly if you would like an informative brochure or more specific information and please help us by letting us know that you heard about us on the WEB, via the O&P Online Community. Thank you!

Vincent Systems

The Vincent Systems GmbH is an internationally active enterprise, dedicated to advancements in medical technology. We design and produce innovative prostheses.

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