Training for a patient with shoulder disarticulation.

This patient received 26 outpatient occupational therapy sessions for a total of 32.5 hr during an 18-week period. All treatment goals were achieved with the exception of psychosocial adjustment issues, which are ongoing. He made significant gains in right upper quadrant muscle isolation and demonstrated control and strength of the upper, middle, and lower trapezius fibers adequate for a myoelectric prosthetic. He also made improvement with left manual dexterity and unilateral coordination with regard to activities of daily living. He was discharged from outpatient occupational therapy services and referred to another medical center for prosthetic evaluation. Twenty weeks after discharge from our facility, he returned for a follow-up visit. He had been fitted with a shoulder cap and his tolerance for wearing it was approximately 10 hr per day. Thirteen weeks after the follow-up visit he resumed outpatient occupational therapy. We are evaluating his tolerance to the placement of a passive arm to the shoulder cap.