<img style="float: right;" src="https://opedge.com/Content/UserFiles/Articles/2021-03%2Fcon1.PNG" alt="" width="500" />When Philip Byrd went to work at his carpentry job one morning in late May 2017, he knew he'd spend a good part of his day cutting boards with a miter saw, just as he had done for nearly the last dozen years. Byrd had used a miter saw so many times as a professional carpenter it would be safe to say operating the tool had become second nature to the 37-year-old Tennessee man. On this day, however, using a miter saw with a 12-inch blade would change Byrd's life. "My hand slipped while cutting a board," he says. "My hand was cut on three different angles, which led to my thumb only being held on by leaders, my palm being completely cut out, and my hand being held on by just the skin at my wrist." Byrd says he didn't know immediately how badly he had been injured. "The pain didn't register right away," he says. A coworker who witnessed the accident, however, knew immediately the situation was dire. He applied a tourniquet to Byrd's badly injured left hand. They scrambled to get Byrd to the hospital, but there were only two ambulances to service the area, and one was already on another emergency. The second unit was more than 15 miles away. Byrd's boss drove him to a halfway point to meet the ambulance. The tourniquet on Byrd's arm had slipped during the ride and he was losing so much blood it had started to pool in his lap. He was flown by helicopter to UT Medical Center in Knoxville, Tennessee, having lost more than four pints of blood. "I was told how lucky I was to be alive," Byrd remembers. Physicians were able to stop the bleeding. "The doctor told me he could amputate my hand right then, or he knew a surgeon in Louisville who could possibly save it. I really wanted to try and save it." Byrd was flown to UofL Health Jewish Hospital in Louisville, Kentucky, known nationally for hand transplant procedures, where surgeons saved Byrd's hand. He started physical therapy, but it wasn't long before Byrd says he started to notice he wasn't able to use his fingers or thumb as well as he had when he started therapy. <img style="float: right;" src="https://opedge.dev/wp-content/uploads/2021/02/2021-03con2.png" alt="" width="500" /> "That's when things started to move in a different direction," he says. When it became apparent he was going to use lose his hand, he was given the option of having a hand transplant. He declined. "They told me I'd have to be on medication for the rest of my life, and I wasn't one to go that route," says Byrd, who ultimately agreed to have a wrist disarticulation amputation. He had the surgery on a Wednesday in August and returned to work that Friday. <strong>A Good Frame of Mind</strong> Initially, Byrd says there was skepticism among some of his family members about his ability to use a prosthesis, and they suggested Byrd go on disability. He was evaluated at more than 50 percent disabled due to his limb loss—but disability or quitting were not viable options for Byrd, a husband and father of five children who operates a 15-acre farm in rural Tennessee. "Disability is a mindset," Byrd says. "No one knew how badly I really wanted to keep using my hand. As long as I can get up in the morning and put my boots on and go to work, then that's what I'm going to do." Byrd says he wanted to live his life as he had before the accident. Before his amputation, he had researched hand prostheses extensively. "I knew my hand was dying and it was going to have to go, so I wanted to find what prothesis would work best for me before it got to that point," he says. <strong>Occupational Therapy, a Positive First Start</strong> That pursuit led Byrd to Bulow Orthotics & Prosthetics Solutions in Nashville, where he began receiving care in January 2018. Byrd needed physical and occupational therapy to strengthen the muscles of his left arm before that care could begin. <img style="font-size: 16px; float: right;" src="https://opedge.dev/wp-content/uploads/2021/02/2021-03con3.png" alt="" /> Enter Stephanie Barker, OT, a therapist at Signature Healthcare at the Fentress County, Tennessee, location. She was the first clinician to treat Byrd as an outpatient after his amputation. She knew precisely what type of therapy he was going to need. "Without his hand to grasp a weight for strengthening the forearm, I had to improvise," Barker says. That meant having to use electrical muscle stimulation (ESTIM) to strengthen and improve endurance in his wrist flexors and extensors, she says. "My hope was that we could decrease the risk of muscle atrophy and improve strength in the flexor/extensor compartments prior to him receiving his myoelectric device." And to improve his shoulder girdle and elbow strength, "We also used a good old-fashioned heavy-resistance band," Barker says. Byrd responded well to ESTIM, Barker says. "He began to produce visible muscle contractions along the forearm following use of the ESTIM. And the strength training of his shoulder and elbow worked well with upgrades as tolerated to eventually using very heavy resistance." Byrd credits much of his early success in therapy to working with Barker. "She was a phenomenal therapist," he says. "After working with her, I was able to use my prosthesis on the very first day." <strong>The Task at Hand</strong> Byrd tried several terminal devices (TDs) before settling on the Taska Hand, Fillauer, Chattanooga, Tennessee, and Motion Control's Electrical Terminal Device (ETD2). "The Taska hand is known for its durability and functionality," says Kelly Hefferan, MPO, CPO, who has been Byrd's prosthetist at Bulow since 2019. "Philip needs a prosthesis that can withstand and perform in diverse environments and activities, from washing dishes at home to feeding livestock on his farm." The fitting process was started by having Byrd perform trials of multiple terminal devices in the diagnostic phase to determine which one would best align with his functional goals and expectations. He also used two Ottobock prostheses, a bebionic and a Greifer, Hefferan says. "We were able to transition Philip to one prosthesis with a quick disconnect wrist to utilize both the Taska and Greifer TD. Diagnostic fitting and the trial period confirmed the candidacy for the quick disconnect wrist keeping length symmetrical to the sound side," she says. "A real goal of our clinical team is to remove as many barriers and likely frustrations as possible for the amputee. Combining the systems into one prosthesis proved to do this for him. As he can easily make the quick change on the fly to th <img style="float: right;" src="https://opedge.dev/wp-content/uploads/2021/02/2021-03con4.png" alt="" width="500" /> e system that best meets his needs at the time." Byrd has worked to make wearing and using his prosthesis a success, Hefferan says. "The patient must be invested in the process. Philip is a committed, resourceful, and motivated individual, a combination that has set him up for success," she says. "Good communication between the patient and the prosthetist sets the foundation for a successful outcome." Byrd has been using the Taska hand for about three months. He says he couldn't be more pleased with his devices. "The Taska hand is the second multi-digit device I've had. It is simply incredible," he says. "The Greifer and the ETD2 are absolute workhorses." <strong>Overcoming the Single Biggest Challenge</strong> Byrd says the single biggest challenge he faces on a daily basis has nothing to do with wearing his protheses. Rather it is finding the patience within himself. "I'm very independent and always have been, and I've always worked with my hands. However, I have had to adjust and adapt to doing things with my [prosthesis]," he says. "That being said, I am very headstrong and determined. I still do most everything I did before. I just do it a little differently now." Byrd still hunts, fishes, farms, rides ATVs and horses, and remains active with his children. He still works full time as an office manager and operates a front-end loader. Especially important to Byrd is his ability to still drive a tractor and his car, which has a manual transmission. "This [the amputation] may have slowed my processes down for doing these things, but I refuse to let it stop me," he says. "I firmly believe you either overcome your circumstances or they overcome you. For me, this is simply a choice." O&P EDGE <img style="float: right;" src="/Content/UserFiles/Articles/2021-03%2Fcon5.PNG" alt="" /> Betta Ferrendelli can be contacted at betta@opedge.com. <div></div>
