There are approximately two million Americans currently living with limb loss, with 185,000 new amputations occurring annually. Over half of all lower limb amputations are major amputations (i.e., excluding toes) and 90% of upper limb amputations occur distal to the wrist. Living with a lower or upper limb amputation can be very difficult. Loss of a limb requires an amputee to adapt and learn new movement patterns in order to complete activities of daily living (ADLs). For unilateral amputees, particularly upper limb amputees, most of these adaptations result in over reliance on the intact side creating the potential for overuse injuries and musculoskeletal disorders. While research investigations involving prosthetics have focused heavily on biomechanical and functional outcomes of lower limb prostheses, fewer investigations have been completed regarding upper limb prostheses, particularly hand prostheses, and even fewer investigations have explored the short- and long-term cost outcomes associated with various types of prostheses. The purpose of this dissertation is to better understand how prosthetics impact financial, functional, and biomechanical outcomes in upper and lower limb amputees.

Chapter 1 provides background information of upper and lower limb amputations and previous work investigating biomechanical and financial outcomes. Chapters 2 and 3 aimed to estimate the short- and long-term healthcare costs associated with various types of upper and lower limb prostheses. The results indicated that advanced prostheses, when compared to less advanced and less expensive prostheses, cost more initially but over time (>4 years) the cost differences were minimal. It was also estimated that lower and upper limb amputation can cost on average $660,000 and $530,000 over twenty years following receipt of a prosthesis, respectively. Chapters 4 and 5 aimed to assess function and kinematics of upper limb movements while performing the Southampton Hand Assessment Procedure (SHAP). Twenty-four healthy and six partial hand amputee participants underwent 3D kinematic analysis as they completed the SHAP. The healthy data were used to develop a normative database in Chapter 4. The results from Chapter 5 confirmed our hypothesis that function was restored and kinematics were normalized when partial hand amputees used an externally powered partial hand prosthesis.

This is the first study to perform short- and long-term cost analyses on multiple limb loss groups to provide insight on the financial burden associated with amputation and the factors that may alter these costs. This is also the first study to investigate how partial hand amputees perform with and without an externally powered hand prosthesis. Our investigation can help highlight how detrimental a partial hand amputation can be and how a partial hand prosthesis can restore lost function. Together these projects can better inform clinicians, payers, and patients on financial, biomechanical, and functional consequences of amputation so that the best healthcare decisions can be made that will maximize healthcare outcomes for the patient while minimizing overall costs.