The ANCHOR: A New Beacon of Light in UE Prosthetics

Toni Thompson

After over 50 years of using below-elbow prosthesis, Debi Latour developed shoulder pain with numbness and tingling in her left arm. She also noticed the development of slight scoliosis. Were these findings possibly related to prosthetic use on her right congenital trans-radial amputation? That got her thinking, "What would happen if a prosthetic user had a stroke that limited or even eliminated prosthetic use?" She wondered if there couldn't be an easier, better way to fit upper extremity prosthesis. That inspired her to develop the Anchor, a patch of plastic attached to the user's scapula and hooked to the prosthetic cable.

An occupational therapist and physician liaison at Shriners Hospitals for Children- Springfield, Debi shares the story, "the True Story of the Anchor." She spent a few years reflecting and tossing around ideas of a more streamlined prosthesis. Then, in November 2005, while participating in a spiritual retreat, she prayed to God for guidance and a purpose. One night, she woke up several times, compelled to pray about her purpose in life, sleeping a little, and then waking up again. After several rounds of waking and praying, she heard a voice, "Are you going listen to me or keep on talking?" In a flash, she envisioned the Anchor on her own back. Wow! Simple. Incredibly simple, based on principles of Brunstrum and basic scapular movements. The idea for the Anchor was born. Now to bring it to life.

Co-workers Kathy LaJoie-Weaver, COTA, and Tracey Sabolevski, CPO jumped on her idea to develop the Anchor into reality. A prime example of using the simple to confound the wise, the device requires a small piece or patch of Aquaplast-T® anti-microbial low-temperature splinting plastic, Dacron webbing, and an overall button/clasp. The overall button is attached to plastic patch by heating the low-temperature patch. The overall clasp attaches to the cable of a Münster, modified Münster prosthetic socket or a neoprene sleeve. For an above elbow device, a longer patch accommodates an additional overall button/clasp to activate the elbow component. The patch is applied just medial to the scapula and lateral to the thoracic spine, utilizing scapular movement to drive the cable. Debi uses an over-the-counter double-sided tape made for both medical and cosmetic purposes to attach the patch to the wearer's back. The patch typically stays on the body from one to five days depending on several factors, including climate, environment, perspiration, skin oiliness and even the user's personal preference. Some agents and strategies can further facilitate the adhesive quality of the tape. Can the wearer attach the patch independently? "Absolutely! –It wouldn't be any good if the user could not apply and remove this independently!!"

How did you get to Shriners Hospitals for Children (SHC)?

Debi is one of the Shriners "double-dippers," both a former patient and an employee.

Phase One:
In 1956, her parents brought their precious infant to Shriners Hospitals for Children- Springfield. They advocated for her to start early with a prosthetic device on her right transradial congenital limb deficiency. Most facilities waited until children began kindergarten to attempt using prosthesis. Debi's parents stressed that they wanted her to have the opportunity to print, color, cut with a scissors, and dress with prosthesis before she started kindergarten. Dr. Kruger, then staff orthopedic surgeon, played an instrumental role in fitting her as an infant. He took Debi's parents' perspectives to heart-and to the Board of Governors. That is how Debi became the youngest person at that time to receive prosthesis at Shriners Hospitals for Children- Springfield. [Image ]

Phase Two:
While raising her two girls on her own, Debi worked as an occupational therapist in the school system. As the girls grew, she juggled part time jobs with the Visiting Nurse Association and an adult rehabilitation setting. But she really, really missed working in pediatrics. After another of her WOW dreams, she woke up and prepared her resume, determined to work at Shriners. That exact day, Easter Sunday 1999, an ad came out in the paper for an opening. Rehab Director Elaine Charest hired her for the part-time position, and soon she advanced to be a full-time Senior OT. A few months ago, Debi took on a new challenge by accepting a part-time position as Physician Liaison for Shriners. She advocates to various facilities and groups to promote the hospital and to provide information for appropriate referrals. She continues to pursue her passion of OT on a part-time basis at Shriners and through teaching in the OT program at Springfield College.

How did you decide to use prosthesis and did you ever go through a period of rejection?

Debi is quick to comment, "My parents never allowed me to reject it. They developed extremely creative ways to have me use it. Once they hid the prosthesis in the sofa and had their friends find it and ask about it. They enlisted other people to ask about it and to ask me to perform tricks with it-anything that focused positive rather than negative attention on me and my prosthesis."

Debi developed her own creative strategies to NOT wear it. She threw it in the trash, hid it, and did everything she could think of to get rid of it. Until the one day that she threw her arm in the trash and her father emptied the trash into the furnace. Debi watched as her father retrieved the burning prosthesis from the furnace with a hanger. That impacting moment: "my moment of truth, made me realize that this was really, really important." She eventually tried everything from playing guitar to wearing strapless dresses.

Did you ever try a myoelectric prosthesis?

"I didn't like heaviness, insurance coverage issues, and battery dependence. There were not enough positives about it for me. I preferred to use the strategic motor planning required by a body-powered figure of nine harness rather than the cumbersome sweaty feel of the myoelectric prosthesis. —And now, of course, I prefer the Anchor!"

As an OT, what do you say to families about their infants, a prosthesis and prosthetic training?

"My philosophy: communicate; —and communicate to understand, not necessarily to agree. I have them communicate their goals, and what they want for outcomes. When they ask, I give my experiences and opinion, but I put no judgment on their choices. I still encourage for a schedule, and recommend incentives for using the prosthesis. The goal is to empower others. Judgment closes the door on opportunities to impact their future."

What is the status of the Anchor now?

Ten Shriners Hospitals now fabricate the Anchor. Groundwork is being laid for those Shriners Hospitals that outsource prosthetic construction. Some facilities utilize the Anchor for children as young as four years old, but Shriners Hospitals for Children-Springfield feels most comfortable fitting children six and older, for several reasons: ability of the child to don/doff the Anchor independently, and skin integrity. The Legal Department at the headquarters of Shriners Hospitals for Children is working on the patent for the Anchor; it is currently in patent-pending status and was published by the USPTO in October 2007. Debi has presented the Anchor at the SHC-Springfield's Kruger Day in May 2007, at the International Society for Prosthetics and Orthotics (ISPO) in Vancouver in 2007, in a web seminar for 14 Shriners Hospitals in January 2008 and at the SHC Hand Surgeons Conference at SHC-Salt Lake City in February 2008. She also presented information about the Anchor at the ACA Annual Conference in Atlanta (June 2008). Debi is scheduled to present a free paper (Creative Solutions) at ACPOC May 2009 and is awaiting word about her abstract submission for the Trent (U.K.) International Prosthetic Symposium (TIPS) also in May 2009.

What are your favorite Anchor success stories?

"They are all special. I most enjoy watching the "moment of impact" after we attach the Anchor and the user operates the terminal device for the first time, using scapular power from the same side as the limb deficiency. There is typically a brightness that flashes, accompanied by the exclamation, 'I'm FREE!!!' That is always a moving moment for all of us!"

"The first adolescent fit with the Anchor and played high school football. Now a college student, he is the winner of five sports broadcasting awards. He wore a traditional upper extremity prosthesis three or four days per week "on and off" and now wears the Anchor 6-7 days all the time."

Debi recently received a call from a medical resident in a surgery program. Her program chief highly recommended that the resident with a below elbow amputation get a prosthesis. The Anchor proved the perfect solution for the demands of performing surgery.

Who is YOUR inspiration and mentor, your Anchor?

"My faith is very strong. I have a wonderful husband. I raised two girls by myself. Now in their 20's, they are amazing, incredible young women, not perfect, but incredible."

Besides Debi's extremely strong faith, she looks to her family as her biggest supporters and her mentors. Her parents never allowed Debi or her five siblings to say or even think, "I can't." They were concerned that Debi might not have friends or ever be able to marry. To be sure she had enough friends, they chose to provide her with at least five friends—her siblings. "We all had chores and responsibilities and no one got cut any slack. My father always stressed that the biggest handicap a person could possess is a closed mind and stressed that we avoid acquiring such."

What are your goals for the next ten years?

"I hope to work a little less and volunteer a little more and enjoy my family." Debi serves on some local Boards of Directors, including the Jewish Family Services of West Massachusetts. For many years, she has played a vital role in the Assemblies of God's Royal Family Kids Camp for children from abusive situations.

She also wants to spread the word to make the Anchor available to more children and adults in the US and in other countries, offering yet another opportunity to promote Shriners Hospitals for Children. Debi and the Anchor serve as a beacon of light in the changing face of prosthetics.

Toni Thompson, MA, OTR/L