In occupational therapy, we often work with prostheses, or artificial devices that replace a part of the human body that may have been lost due to trauma or accident, congenital conditions or other reasons. Patients who receive prosthetics will typically go through rehabilitation as they learn how to use the new limb. Their medical providers may include doctors, physiatrists, and physical and occupational therapists.
Our occupational team at OrthoCarolina has worked with prostheses for many years. Trust issues are also part of occupational therapy as patients learn to acclimate themselves to a change in their physical body, and how it affects them daily.
One of my patients is a partial hand amputee on the right side and received a myoelectric hand. Together we have worked through wound care, fractured thumb, compensation strategies and regaining motion and control with his remaining limb. Before fitting the hand to his arm, we worked on muscle isolation for controlling the hand, training for prosthesis wear and use with several splints. When it was time for the new hand, he and I traveled to Touch Bionics in Ohio together for his fitting and training to use his new limb. Before the myoelectric hand, he only had a thumb remaining. Now he has a battery powered, microprocessor-driven hand with four individual fingers paired with his thumb, and it looks like he is wearing a glove.
Since getting his new hand, we have worked together as he learns and relearns skills. We work on picking up items, tying shoes, writing, eating and fork use, working up to gross grasp and holding tasks like opening letters, taking tops off bottles, physically storing of one to three pound kitchen and household items, sweeping and other tasks.
The new hand is what we call an assistive hand, and is best for light tasks and household or light shop use. All of this particular patient’s heavy lifting is still with his right forearm and left upper extremities. The average wear time for a prosthesis is four to six hours, and we are working to get him to three, two-hour sessions of wear in home and community per day. Learning how to use and wearing prosthetics can be exhausting for a patient, but with careful work our ultimate goal is to have him functioning as close to normal as possible.
Robert W. Pippin, MS, OTR/L, CHT is a hand therapist at OrthoCarolina Concord.