The Play Attachment Project: Rethinking the Split Hook

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By Marjorie Tulloch

The split hook is offered in the prosthetics departments at many pediatric care facilities as the most functional option for limb-absent children age two and over. I have found that most children are unable to open mechanical hands due to the high pull force required to overcome the tension in them. By contrast, split hooks are easier to operate because the rubber bands that provide tension to the grip can be altered to suit the user's needs—added to which they are lighter, more reliable, and easier to maintain. 


Unfortunately, despite its advantages, the split hook has negative connotations: It is perceived by many as ugly and outdated, and parents have an associated fear of stigmatism for their children. Over the years my colleagues and I at the Harold Wood Long Term Conditions Centre, Romford, England, have also regularly heard negative comments about its appearance. These issues led our team to investigate the creation of a child-friendly and customizable cosmetic attachment that would make the split hook more attractive and desirable. We decided to conduct a split hook makeover. We first asked ourselves what would make the split hook more acceptable to children and their parents? We decided we needed to change the color, disguise the hook, make it more playful, and personalize the design.


Initial designs used a combination of Lego blocks, screws, and glue to build a Lego platform on top of the split hook, as well as colored sheaths on the hooks so that the prosthesis could become part of a child's play habits. This play attachment produced consistently positive results.


We used a colorful silicone tubing to replace the original beige-colored rubber covers for the hook "fingers." Being able to give children choices of colors for the silicone tubing and Lego allows them to get involved in the design process and make their device personal to their own tastes. The children can also use their own Lego sets to personalize their prostheses.


We call the new design the Play Attachment. Throughout the design process, it has been our aim to make the Play Attachment easy to manufacture, inexpensive, and therefore available to the widest audience. The latest version should be possible to manufacture without needing a workshop or high level of technical skill. The parts required to build a Play Attachment would cost around £15 (about $19).


We are currently in the process of investigating a 3D-printed version of the Play Attachment, however exploring this option further has become complicated due to the ethical issues relevant to the creation of a new product. We discovered that while the Play Attachment is neither a medical device nor accessory, we cannot recruit participants from within the National Health Service to trial it without going through a complicated ethical process. It seems to be easier and cheaper to manufacture in-house using readily available Lego bricks and discs, as part of a patient's normal care.


If you would like to find out more about our project, ask questions, or build your own Play Attachment, please contact me. I would be happy to supply the list of instructions and parts in return for some feedback on the design.


Marjorie Tulloch is a prosthetist at Steeper Group, Leeds, England, at the Harold Wood Long Term Conditions Centre, Romford, England. She can be reached at