Three Challenging Case Studies for Partial Hands
Janet G. Marshall, CPO (Photos by: Noelle Vallet and Janet Barber), Shriners Hospitals for children; Tampa, FL
Case Study 1 Profile:
- 7 year old male, premature birth
- Hemiplegic, right side affected Thrombosis of radial artery of left hand resulted in Left partial hand, with large palm, no digits
- Left normal ROM and strength ofwrist
- Left normal sensation
- Write with Left hand per teacher request
- Use of table knife for cutting food
- Use Left hand for zipping pants
A wrist hand type orthosis was designed with an opposing cushioned platform extended under the palm. Interchangeable handles that held a pen/pencil at an angle allowed writing by gripping the tool between the palm and platform. The opening was covered with colorful foam that was cut to accept different diameters. Similarly, a separate tool was made to accommodate a knife for cutting food. A pinch force of 9 pounds was measured by a dynomome-ter. A small hook was incorporated in plastic on the medial side for zipping pants. A ring was placed on the zipper for ease of use.
Case Study 2 Profile:
- 9 year old male
- Congenital partial hand with second and fifth digits
- Limited ability to oppose
- Needs to maneuver bike for competitions including jumping with quick release for safety
A wrist hand orthosis was designed that gripped the handlebar adequately to maneuver. However, in the trial of this, the top portion was eliminated so the hand could be pronated for use of the fingers. The lower portion allowed a lifting capability for jumps. A removable Velcro loop grip was placed on the handle and Velcro hook was riveted to the palm aspect of the orthosis for quick release as a safety factor.
An alternate biking glove was made for a child with a thumb, but no digits. An existing neoprene glove used in OT was altered by seaming the distal aspect. Velcro hook was then sewn into the palm of the glove. A removable Velcro loop grip wrap was made for the handlebar. An advantage of the glove was that better dexterity and sense of touch was maintained.
Case study 3 Profile:
- 16 year old male
- Traumatic partial hand, partial palm, no digits
- Wrist intact with normal ROM and sensation
- Cosmetic and functional prosthesis with no harness
A functional tenodesis prosthesis was fabricated with copolymer, and a hollowed passive hand. The volar aspect was designed by applying the molten copolymer thumb during the vacuum pull stage of fabrication. Positioning and shaping the thumb starts then, but can be further modified and perfected on the router and with a heat gun. The palm piece is attached by a single axis hinge placed at the radial styloid. The fingers from the passive hand fit over the vacuumed formed palm and are attached with glue and rivets. When hollowing out the hand, it is easiest to remove the metal finger wires by unwrapping the coils, which will pull the wires with them. The wires can be trimmed and replaced for positioning the fingers after the hollowing process. The cosmetic glove needs to be split to be donned over the prosthesis. Super glue adheres well to maintain a secure fit. It is necessary to patch areas, but the edges can be sanded and smoothed to give a pleasing appearance. Advantages of the split glove is that a wider opening is achieved, and it is cooler for the patient. Since the thumb was well opposed to the fingers, a pinch force of five pounds was measured on the dynomometer, and the opening was adequate for holding a drink can.
Creative solutions to the demands of partial hand patients continue to challenge the prosthetist. When results are beneficial to the patient, and they actually use the device, it is extremely rewarding. The above case studies are just a few of the success stories from the past year. Sharing new ideas and working with different materials to improve upon old ideas will be the focus of future endeavors.