Billiards and Pool for the Physically Handicapped Child
A prime goal in the rehabilitation of upper-extremity amputees is to restore function to a level as close as possible to that present prior to the amputation. This holds true for both practical and recreational activities. In conducting a truly well-rounded program of post-amputation treatment, therefore, training for play should be provided as well as for feeding, dressing, and working.
This need for recreational training is even more important for adolescent amputees than it is for adults since in this younger group peer acceptance is based to a large degree on ability to enter into the activities of the group. At Gillette Stale Hospital extra attention is given to our juvenile amputees in attempting to show them that, with training, the prosthesis can be an excellent substitute for the missing limb. Our program operates on three levels:
Evaluation of interests and suggestions for programs of activities.
Training in the use of adapted devices after surgery and before application of the prosthesis.
Substitution of the prosthesis for the adapted devices.
This paper deals with the last two steps in our program and describes how we follow this pattern in teaching pool and billiards to our upper-extremity amputees.
There are basically three types of adapted devices used in this training program and each is easily made in an orthotics, prosthetics, or carpenter's shop. The material used is generally scrap wood or metal which can easily be found or purchased at a maximum of about 60 cents for each project.
Adaptive Device No. 1
This item is an inexpensive "bridge" or •'crutch" made of plywood. The amputee who has lost his dominant hand and must learn to exercise control with the non-dominant hand finds this device to be most useful (Fig. 1 ).
One piece of 1/4 or 3/8 in. plywood, approximately 4 in. by 6 in.
One old cue or piece of 3/8 in. dowel
One 5 in. strip of moleskin or light leather
With a hand or coping saw, trim the piece of plywood into the shape of a half circle. Round off the edges with sandpaper. With a 3/4 in. hit, drill three holes in the half circle. Two of the holes are placed 3/4 in. from the flat bottorn part of the half circle and 1/4 in. from its outer edges. The other hole is placed in the middle of the board with its outer edge 1/4 in. from the top edge.
A hole for the handle is drilled so that it is in the middle of the half circle and its outer edge 1/4 in. from the bottom of the board. This hole should be of a size to provide a snug fit for the handle which should be glued or wedged in.
Sand any rough edges and paint. When the paint is dry, put moleskin or leather on the bottom of the cue rest to protect the playing surface of the pool table.
Adaptive Device No. 2
This cue holder is slightly more stable and somewhat more permanent than the first since it is made of steel. It is a one-handed bridge which has been of great benefit both to amputees and to other patients with upper-extremity injuries where only one hand is functional (Fig. 2 ).
Two pieces of 7 1/2 in. by 1 in. by 1/8 in. stock steel
One eyebolt with 3/4 in. opening
One nut to fit the eyebolt
Bend the stock steel into half circles so that they will fit together in a crisscross pattern. It may be necessary to trim one leg so that the pieces will fit properly. Weld or braze the two pieces together and drill a hole through the junction large enough to accommodate the eyebolt. Sand or file the welded joint to a smooth finish and paint. Pass the eyebolt through the washers and the hole, put on the nut and tighten it until there is a little play or swivel in the eyebolt. Make a mark on the bolt right below the nut. Disassemble and saw or cut the eyebolt at this point. Coat the eyebolt and nut with oil and reassemble.
The eyebolt should swivel easily but not slip from side to side. When it functions to your satisfaction, set the nut by using a punch on the cut end of the eyebolt. The punch will expand the threads so that the nut will not work loose.
To protect the surface of the pool table, the four legs of the rest may be covered with moleskin.
Adaptive Device No. 3
This simple device was designed and used by an older gentleman, an amputee, who suggested its use for our children. Although the designer had had parts of his aid machined and used ball-bearing wheels, we have found that simple wheels and axles and a block of oak or white pine were sufficient for training our patients to shoot pool (Fig. 3 and 4 ).
One piece of oak or other hard wood block approximately 3/4 in. by 1-5/8 in. by 2-3/8 in.
Two strips of 12 gauge aluminum 2-1/2 in. by 3/4 in.
Two model car axles
Four model car wheels to lit axles above
One block of leather or rubber approximately 3/4 in. by 5/8 in. by 1-5/8 in. (Fig. 5 )
Two 1/16 in. stove bolts and nuts
Drill two holes through the long block of wood to hold the axles. These holes should be no more than 1/8 in. from the bottom edge of the block and approximately 5/8 or 3/4 in. from its ends (Fig. 6 ). Drill holes through the center of both metal strips 1/8 in. from each end.
Attach the metal strips to the block with bolls or rivets. Drill a 1/8 in. hole five inches from the tip end of the cue. Align the metal strips on each side of the cue, put the stove bolt through one strip of metal, through the cue and then through the other strip of metal. Tighten the nut on the boll. Clip off the excess bolt.
Place the axles through the bottom holes and put on the wheels, checking to see that they are free wheeling and level. Glue the 3/4 in. square of rubber on the back edge of the block of wood to act as a bumper.
The use of adapted equipment can be either beneficial or detrimental to the amputee and it is entirely our use of these assists which determines what the outcomes will be. With the amputee who has recently lost his arm, they are a definite advantage in that they allow him to actively participate in the activity during the healing and fitting process. They can be detrimental if they are used in place of the prosthesis when use of the artificial arm is feasible. The therapist who allows the upper-extremity amputee to continue using an adapted device after he has received his prosthesis and training is misinterpreting the purpose of these devices.
Although most of these adapted devices were developed for use with amputees, their use is definitely not limited to this group of patients. Children who have used these bridges include those with cerebral palsy, hemiplegia, muscular dystrophy, arthrogryposis, and upper-extremity injuries.
In games such as pool and billiards, adapted devices are used for two major purposes:
To show the unilateral amputee that his remaining arm, even if it is not the dominant one, can be successfully used in play activities.
To lay the groundwork for participation in activities using the prosthesis.
Lee Rullman is the Activities Director of Gillette State Hospital Saint Paul, Minnesota