A Pencil Holder For The Bilateral Upper Extremity Amputee Fitted Unilaterally
Patricia L. Calef, O.T.R.
The ordinary two tine grasp or pinch utilized in the performance of many activities is, perhaps, the most common type of prosthetic grasp employed by all upper extremity amputees. Depending on the number of limbs involved, the level of amputation, and the degree of skill acquired, the amputee will either: 1) pick up an object in this manner and then manipulate it against a solid base to obtain the best angle for use; or 2) he will use his remaining hand to place the object in the hook in the desired position for use.
However, this type of grasp is not satisfactory for activities such as writing, or holding a knife or fork for cutting, which involve the application of a great deal of pressure against the movable tine. In activities of this type, the pressure of the work against the hook weakens the grasp and the object slips, or is unstable. The type of grasp that is most effective for writing is depicted in Fig. 1 . The operating lever of the hook acts as a stabilizer and the pressure of writing then increases rather than decreases the grasp pressure.
Unfortunately, the young bilateral upper extremity amputee fitted with only one prosthesis cannot achieve this grasp pattern easily. In an attempt to remedy this problem and to satisfy the child's need to be as independent as possible in the school situation, a new piece of apparatus was designed for a patient in our clinic (Fig. 2 ).
The apparatus is made of plexiglas, which is available from any plastic supply source. The cylinder is of 3/16" stock and is 4" in diameter, while the base, end disks and side supports are of 1/4" thickness flat stock. The inner portion of the cylinder is lined with foam plastic to provide friction to hold the pencils. Pencil holes are placed 3" apart on the cylinder to provide adequate working space for grasp and manipulation.
The holes in the foam were tapped out with a steel punch slightly smaller in diameter than the pencils and those in the plastic cylinder were made slightly larger and countersunk. The foam liner was glued to the cylinder with white glue and threaded screw holes were drilled in each end disk which were then glued to the cylinder. The holes in the uprights were not threaded and were made slightly larger in diameter than the screw holes. Leather washers placed between the uprights and the end disks provide adjustable resistance to cylinder rotation as the screws are tightened or loosened.
At the request of the patient, an additional small square of 1/4" plexiglas was glued to the front left edge of the rectangular base, creating an angled corner (Fig. 2 ). After he grasps the pencil, the patient places the point in this corner and then loosens his grasp slightly in order to slide the hook down closer to the tip for greater control. The process is reversed in preparation for replacing the pencil in the holder.
Since pencil crayons are easier for the amputee to use than ordinary crayons, the holder was designed to hold a full set of colors. To accommodate the length of the pencils, it was necessary to lengthen the uprights in order to rotate the device. Thus the greatest disadvantage of the holder in its present design is the excessive height, which requires the child to stand up in order to grasp the pencils.
The chief advantage of this apparatus is that it is a reasonably simple and inexpensive piece of equipment to make. It has been in constant use for a period of six months and has required no maintenance to date.
Patricia Calef is associated with the Juvenile Amputee Clinic, Handicapped and Crippled Children's Service District of Columbia, General Hospital, Washington, D.C.