Conceiving the Extraordinary: Groundbreaking Solutions to Upper-Limb Challenges

Those who choose an O&P career are usually motivated by a shared desire to provide enabling solutions to those with disabilities. Faced with an unusual patient need in the exotic realm of upper-limb prosthetics, dedicated professionals become problem-solving pioneers and embrace the challenge with enthusiasm and innovative energy. In the interest of inspiring others to pursue similarly rewarding results, several experts agreed to share their pathways to resolving a patient’s unique problem with insightful creative solutions. Telescoping Forearm Tim Bump, MSPO, CPO, clinic manager, Handspring, Utah, describes a challenge his team resolved for a patient with a shoulder disarticulation. “The primary goal was to provide something very straightforward and simple to use for a patient who didn’t want to have to coordinate an elbow, a hand, and a wrist rotator in conjunction just to make a sandwich or help prepare or eat a meal. [caption id="attachment_280812" align="alignright" width="300"] A button-controlled telescoping forearm integrated into a 3D-printed prosthesis enables the user to have functionality seated at a table. Photograph courtesy of Handspring. [/caption] “We wanted a myoelectric hand for this patient who needed to be able to do these things while sitting down at a table or standing up at a counter. Instead of using an elbow that flexes and extends, we created a telescoping forearm piece which extended at the touch of a button and slid forward to snap into place.” The hand or arm could be placed in multiple positions by using his other arm, Bump says. Instead of a series of steps to control and place the elbow in the right position, then adjust the wrist, then either reposition the elbow or position the body to control the hand to be able to grip something, the Handspring team streamlined the process. “We simplified those steps so that the patient only needed to position their arm, then open and close the hand.” Their patient is successfully using the device and may be interested in adding another layer of control to the process, which would potentially offer even more options, Bump reports. He mentions another unusual patient request that involved the need to handcuff people. “Like a couple of other requests, this one hasn’t gone anywhere because a number of factors make it difficult to be able to guarantee a successful outcome,” he explains. Troubleshooting Shooting Shane Grubbs, CPO/L, FAAOP, director, ProCare Ottobock.care, Georgia, admits that the unusual prosthetic challenges can be the most engaging by stripping the challenge down to the simplest design that helps the patient accomplish a goal. “Upper extremity draws in a lot of creative people, and creative people usually take innovative gambles,” he explains, noting that in his role he is often called in to assist in troubleshooting challenging cases. “We’ve resolved cases with patients who needed to operate a chainsaw safely, motorcyclists who steer by inserting their body-powered hook in a hole created for that purpose, and patients attempting to do rigorous weightlifting or sport. “One of the interesting cases we had was a young accident victim with a really short transhumeral limb who hadn’t worn a prosthesis yet and was reluctant to do so, although his family was encouraging him to try. “Our ProCare team was led by clinician Andrew Nash, CPO/L, who had limited experience in upper limb, but a wealth of innovative ideas. He was supported by Stephen Shulte, CP/L, FAAOP, and Brent Wright CP, BOCO (Advanced 3D), on the printing side. [caption id="attachment_281102" align="alignright" width="277"] Nash checks the socket alignment and comfort. Photograph courtesy of Shane Grubbs. [/caption] “We made a socket apparatus that was more like a shoulder disarticulation and used some interesting pieces and equipment so that he could shoot skeet with his dad again,” Grubbs says. “He used the trigger with his anatomical side, but it was kind of like a positioning turret for his shotgun, and then we were trying to adapt it to riding four-wheelers, too.” “After evaluating the patient,” Nash explains, “it was clear that shooting, riding his ATV, and fishing were his top priorities. Having done these activities in my youth allowed me to relate and think through each challenge. “The first was how to help hold a rifle or shotgun. The patient had told us that dove season was approaching, and he would like to shoot his shotgun first. He and his father were practicing shooting with his nondominant hand, so I knew he could control the weapon with his left arm but needed to rest the forearm of the gun to allow aiming. We had to find a way to allow for adjusting the positioning of the gun while holding it firmly. Naturally, I went to the hardware store to walk around and see what was possible. I found an adjustable flagpole holder to act as the elbow. One-inch PVC fit perfectly into the holder and allowed us to create and bond a trough to hold the gun’s forearm at the correct angle. Having the patient bring his weapon to the office felt odd but necessary to get it correct. With him there, we were able to mock up the correct angles and distances to allow him to safely hold the shotgun. “Next, we moved outside to his ATV. The patient sat on the seat to allow us to mock up the correct grip angle and length to comfortably control the handlebars. While moving the handlebars with his prosthesis was difficult, it created increased stability and safety while riding. “Finally, we needed to be able to hold his fishing rod. Stephen had suggested that we adapt a RAM mount, typically used on boats to allow for holding the rod. We created an adapter that connected via PVC to the RAM mount. The patient was able to cast with his sound side and then place the rod in the holder and reel it in. [caption id="attachment_281103" align="alignright" width="375"] The patient is evaluated for the definitive socket fit. Photograph courtesy of Shane Grubbs. [/caption] “The success of this design was because the parts were modular and the angles could be adjusted as necessary. Brent did an incredible job putting it all together and allowing the parts to be swapped quickly. “It was incredibly satisfying to see the videos of him shooting and riding his ATV. The success of the project came from everyone being open-minded and not afraid to try something different. Trial and error are part of the learning process—and necessary to have the desired outcome. It’s time consuming, but when the patient is on board it’s a lot of fun.” OI Solutions “As we get into the world of osseointegration (OI) and bone-anchored devices, giving somebody a thumb is probably one of the more unique things that we have done or do,” says Brooke O’Steen, OTR, ForMotion. “And the patient experiences instant function—instant!” Josh Kinsey, CPO, ForMotion, agrees that embarking on the OI space has recently been a significant emphasis for their team. “We constantly need to be creative and have our technician make custom humeral sections from scratch, drilling plates out and then tapping them himself, even though he’s not a machinist.” The ForMotion team has tackled a list of one-of-a-kind challenges, including attachments and adjustments for BMX and semiprofessional ATV riders, space for an Apple watch, embedding an air tag, modifying existing hand components, and even halving the size of the components as needed to fit patients. O’Steen describes a patient who needs a custom silicone mitt rather than a finger. “He wants to be able to bring his thumb over to the mitt, as a post or opposition, so he can hold and grab things like canoes and paddles.” “We’ve removed elbows, for more activity-specific casts,” Kinsey adds. “A worker at a packing plant performed a very specific task where her hand needed to be consistently at one level. We bypassed her elbow because by the time she sequenced to get her elbow in the position that she wanted, it was taking too long.” In serving the needs of a wide variety of patients, each with specialized needs, “Everything we do is unique and unusual.” O’Steen points out. A Soldier in the Desert John M. Miguelez, CP, FAAOP(D), president, senior clinical director, Arm Dynamics, California, tells the story of his role in returning a patient to active military duty in an inhospitable environment. “One of the most unique devices we’ve ever developed was for a US Special Forces soldier named Andy who had sustained a transradial amputation. His goal wasn’t simply to return to daily life. He wanted to requalify for active duty and deploy back to Iraq. “At the time, he was using a myoelectric prosthesis with an ETD [electric terminal device] and an Ottobock SensorHand Speed. During our planning sessions, we realized we had a significant operational problem. The prosthesis depended on rechargeable batteries, but he would often be operating in remote desert environments where electrical power simply wasn’t available for extended periods. “That challenge drove our design process. Rather than focusing solely on the prosthesis itself, we looked at the entire mission. The question became, ‘How do we make sure he can keep using his prosthesis when there is no power source?’ “The solution was to integrate a lightweight solar charging panel directly into his military rucksack. We custom-sewed the panel into the pack and configured it to recharge the prosthesis batteries while he was in the field. In effect, his backpack became a portable charging station that allowed him to remain operational during extended deployments. “The greatest challenge wasn’t building the solar panel itself. It was creating a reliable, rugged system that could withstand the harsh realities of military operations while delivering enough power to keep the prosthesis functioning. Every component had to be durable, lightweight, and dependable because equipment failure in that environment wasn’t simply an inconvenience—it could affect mission readiness and personal safety. “That project reinforced an important lesson for our team,” Miguelez concludes. “The best prosthetic solutions don’t always involve creating a new prosthetic component. Sometimes the real innovation comes from understanding the individual’s environment, anticipating the obstacles they’ll face, and engineering a solution that allows them to accomplish what matters most to them.” Judith Philipps Otto is a freelance writer who has assisted with marketing and public relations for various clients in the O&P profession. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer.

Conceiving the Extraordinary: Groundbreaking Solutions to Upper-Limb Challenges

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Conceiving the Extraordinary: Groundbreaking Solutions to Upper-Limb Challenges

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Hurdling the Barriers: Helping Patients Achieve and Succeed with Multiple Upper-Limb Devices

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