Successful Voluntary Grasp/Release Using the Cookie Crusher in Two-Year-Olds: Two Case Reports

JUDY MEREDITH, O.T.R./L., JACK UELLENDAHL, C.P.O. ROBERT PICKEN, M.S., C.P., AND ROBERT KEAGY, M.D.


Professionals working with the wide array of upper-extremity amputations and limb-deficiencies must often address the difficult problem of assessing the relative merits of the various prehensor control schemes. The Cookie Crusher circuit is an electronic package which causes the hand to open in response to muscle contraction and closes or "crushes the cookie" when the muscle is relaxed. We compared the function of the single-site Cookie Crusher system with cable-operated mechanical devices in two two-year-old children. Prior to their beginning to use the Cookie Crusher (B. W. at 25 mos., J. C. at 30 mos.), both children were consistently good prosthetic wearers, beginning with their initial passive devices, and progressing through their body-powered hooks and hands. However, neither had developed voluntary grasp/release in spite of 12 to 16 months using cable-operated prehensors. Both children rapidly developed a voluntary grasp-release for the first time-within 30 minutes of starting to use the Cookie Crusher. The more adept of the two children, a female with a traumatic above-elbow amputation, showed prehensile function with the Cookie Crusher even in spontaneous activities, e.g. playing. We infer that the Cookie Crusher prehensor fits the cognitive scheme and prehensile needs of these, and possibly many other two-year-old limb deficient children. We will continue to follow the choice of effective control schemes in these children as they mature cognitively and functionally.

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