This is a summary of the responses that I received regarding the UCLA CAPP
TD. I thank everyone who provided me with information. If anyone else can add
anything to these responses, I will appreciate any information.
Steven P. Chambers
In my opinion there are many better choices than
fitting a client with the CAPP TD. In my experience
with clients who have the CAPP TD, and that experience
is limited, the parents do not like the CAPP because
of its appearance and most of the users can only
perform basic grasping functions with the CAPP. Manual
dexterity with the CAPP is extremely limited.
please see my reply below.
On Wed, 1 Mar 2000, Steven P. Chambers wrote:
> I am not too familiar with pediatric prosthetics. I have read some articles
> regarding the UCLA CAPP TD. Is this TD still widely used for pediatric
it is in my experience a very regional prescription.
when i worked in the east, the prosthetists all tell the patients it looks
like an aligator and it is not very cosmetically appealing.
if you see patients from ACPOC clinics ( go to www.ACPOC.org ), many of us
use it for young children for the following functional reasons.
>What are the advantages and disadvantages of the UCLA CAPP TD?
-it was designed specificly for children’s activities at that age
-therefore it has built in wrist flexion for bimanual activities
-it has a large width of opening for the large toys that they play with
-it has friction surfaces designed to accommodate to the variety of shapes
-its frame is very durable but has friction surfaces where they would need
-it is cleanable! by disassembly by the parents
-it can be passively applied until it is activated
-it can have a center pull or lateral pull cable and amazingly, the dacron
cable has demonstrated itself to be more durable that the steel ones in
some of the kiddos
-the location of the cable exits allows ease of dressing as there is no
thumb post sticking out to get caught in a sleeve
well, since there is no free lunch in our profession, i feel it has some
-the covers need to be replaced fairly frequently, but this was built into
the design as to get a high coefficient of friction for minimal pinch
force, the material needed to be replaceable, however, they are
relatively inexpensive and applied by parents quite easily
-the pinch force itself is not great. its design depended on the
friction rather than raw pinch force. however, the surfaces can be
creatively used in grasping while having only minimal pinch force. the 3
springs can be changed out quite easily to vary the pinch forces. this
allows you to get accidental opening until they figure it out, then
increase the pinch as their functional requirements change, quite clever,
-the discussion about cosmesis is a valid one, but form follows function
and beauty therefore cosmesis is in the eye of the beholder. will any TD
be as cosmetic as having 2 of original issue?!
> We do have four patients at our clinic who are using this device but all of
> them are patients who have transferred in to our clinic. I am wondering if
> this TD would be something to consider fitting future pediatric patients
if you can get by your own biases, it would be nice to consider it. but
as i tell all my families, not having a prosthesis works also, and the
prescription is a tool and an opportunity to learn to use one while the
brain is young. and the tool has to fit the task.
Ramona M. Okumura, CP
Lecturer, Division Prosthetics Orthotics
Dept. of Rehabilitation Medicine, #356490
School of Medicine
University of Washington
Seattle, WA 98195-6490 USA
FAX (206) 598-4761
Steven and List members:
Here are my comments regarding the CAPP TD. I work at Shriners Hospital –
CAPP and we fit many of these devices.
1. The CAPP TD is a nice device for the infant (first prosthesis) since
parents can passively open the TD and place toys inside. The only problem is
that it does not look like a hand.
2. The CAPP TD when activated with a cable/Dacron line (around 18-24 months)
is easy for a toddler to learn to use. These children can get good opening,
place an object inside, and relax tension on the line for closure. The CAPP
TD holds most toys/objects fairly well. Toddlers are not developmentally
ready to handle some of the other types of terminal devices.
3. The only objects/activities that we have found the CAPP TD to not work as
well with: bike handles or other cylindrical objects. Mechanical hands tend
to work better since objects fit nicely into the well of the hand.
4. The CAPP TD is usually appropriate until the child is 8-10 years old.
Although we do have some older children who like and want to continue with
this device. Most girls tend to choose a mechanical hand after. Some boys
switch to a hook/TRS if they are interested in function. We have limited
resources for myoelectric devices as a choice.
5. The child definitely needs training to learn how to use any type of
terminal device. Parent encouragement and support is essential.
You can contact me if you have any specific questions regarding the CAPP TD
or any questions regarding upper extremity pediatric patients.
Joanne Shida, OTR
Shriners Hospital – CAPP
e-mail: [email protected]
You probably should contact Julie Shaperman OTR who has been heavily
involved with the CAPP TD development and has worked with many children
fitted with the CAPP TD. Her email is [email protected]
Hope this works out.