Name of the Procedure:

Powered Upper Extremity Range of Motion Assist Device (Custom Fabricated)

• Common Names: Powered arm, wrist, and hand assist device, upper extremity orthotic.
• Technical/Medical Term: HCPCS Code L8702.

Summary

This procedure involves the custom fabrication of a powered device designed to assist with the movement of the elbow, wrist, hand, and fingers. The device includes microprocessors, sensors, and all necessary components and accessories to aid individuals who have limited upper extremity mobility.

Purpose

The device addresses conditions that impair upper limb mobility, such as muscular dystrophy, spinal cord injuries, or severe arthritis. The goal is to increase the range of motion, enhance functional capabilities, and improve the quality of life for individuals with impaired arm, wrist, and hand function.

Indications

• Loss of upper extremity strength or mobility due to neurological or muscular conditions.
• Severe arthritis that limits joint movement.
• Post-surgical recovery where increased range of motion is needed.
• Spinal cord injuries resulting in partial paralysis of the upper limbs.

Preparation

• Ensure a thorough medical assessment to determine the custom specifications of the device.
• Pre-procedure diagnostics may include range of motion testing, muscle strength assessments, and imaging studies.
• No special fasting or medication adjustments are typically required.

Procedure Description

• Step 1: Initial Consultation: A healthcare provider evaluates the patient's condition to determine the need for the device.
• Step 2: Custom Fabrication: Detailed measurements of the patient’s arm, wrist, hand, and fingers are taken.
• Step 3: Device Construction: Using the measurements, a custom device is fabricated. This involves incorporating microprocessors and sensors into the device for precise control.
• Step 4: Fitting: The patient tries on the device for adjustments and to ensure proper fit and function.
• Step 5: Training: The patient is trained on how to use the device effectively, including any necessary exercises to integrate with their daily activities.
• No anesthesia or sedation is needed.

Duration

The entire process from evaluation to fitting may take several weeks to a few months, depending on customization needs and adjustments.

Setting

The procedure involves outpatient visits to medical or rehabilitation centers.

Personnel

• Orthotists
• Physical or occupational therapists
• Rehabilitation physicians
• Technicians for device construction

Risks and Complications

• Skin irritation or pressure sores from device use.
• Mechanical failure or malfunction of the device.
• Allergic reactions to materials used.

Benefits

• Improved range of motion and functional mobility of the upper extremities.
• Enhanced ability to perform daily activities independently.
• Potential for pain reduction due to decreased strain on joints and muscles.
• Benefits are usually noticeable shortly after consistent use.

Recovery

• Follow-up appointments for adjustments and assessments.
• Regular monitoring of skin condition.
• Recommended exercises to maximize the benefits.
• Recovery time varies; incorporating the device into daily life may require a few weeks of adaptation.

Alternatives

• Passive arm orthotics.
• Physical therapy alone.
• Surgical interventions.
• Each alternative has its pros and cons based on the functionality, invasiveness, and specific patient needs.

Patient Experience

• The patient may initially feel the device is cumbersome but will adapt over time.
• Some discomfort during initial use is common but typically resolves.
• Pain management and comfort measures include ensuring the device is correctly fitted and remains adjusted to prevent pressure points.