One day...two arms. Probably the toughest task given to us the whole semester. Starting a new body part is tough because I am always clueless when it comes to modifying - as I should be, this is school. We typically get a day or two to get the modifications done before moving on to completing whatever limb we are making. This is not the case when there are only 2 weeks left until graduation!! We casted in the morning, modified in the afternoon and completed the entire arm by the end of the day. It was insane. And awful :)
I forgot to take a picture of just the plaster mold, but let's be honest...we have seen about a hundred of those over the last few months. We were told the modifications for this arm should only take about half an hour - again, let's be honest...it took me a solid two hours. That is okay, all in the name of learning!! After modifying the mold, it was time to do the vacuum plastic - this time we used a more flexible plastic in order to make it easier for our patients to get their arms into the socket. This made for a quick and easy melting and vacuum forming process. Thank goodness for something that was quick and easy at this point in the day!
After getting the plastic socket made came the craziest thing I think we have done yet - and that is saying a lot considering all the things we have made this semester. I need to make the crazy scale relative - it was not the craziest thing as far as most intense or greatest impact or any of that...it was the craziest thing as far as in the world of science and materials. Because these residual limbs are so short and they need to made into a full length arm to match the sound side limb, we have to foam material over the socket to add the length of the prosthesis. So, I took plastic, made a funnel cover and then mixed two liquids together in a cup and poured it into the funnel and it literally became foam. It was amazing. When I poured it in it only came up about one third of the way of the funnel and then with the power and magic of modern science, it started to become foam and slowly rose out and over the top of the plastic funnel. I felt like I was in the 6th grade making an erupting volcano for the science fair...I was like, when do we get to do this part again!? After about 15 minutes, the foam is set and ready to go. Then it was just about sanding it and trimming it down to make it into the shape of an arm...or somewhat into the shape of an arm. Regardless, I do not feel like I am doing the foam part justice, but trust me, it was the highlight of the day.
After getting the foam right, I fiberglassed over the whole thing (to provide some rigidity and strength since we are not laminating these) and then began to attach all of the components. When I said I was making this from scratch, I was not kidding. I put on the wrist unit, I was attaching straps with rivets (okay, confession, I could have sewed the straps, but I found ones that were already done in the bin at school), I screwed the hook in and I even made the whole cable by myself. Stringing wire through the housing, melting Teflon, using wire cutters - pretty tough stuff :) After getting everything hooked to the arm, I attached the triceps cuff and the shoulder harness and the arm was done and ready to go. And so was I!! This was so much to get done in one day that I really never thought it could happen. It is crazy to look at the first picture right after doing the vacuumed plastic and then to think a few hours (an eternity) later, it is a prosthetic arm all ready to go...with a working hook and everything! What a day!! And just when I thought it was over and I could go home and get the plaster and fiberglass out of my hair and off my shoes...we were told we had to pull our second arm socket. That is right - I forgot to mention that when we casted our patients in the morning, we actually casted two patients each!! They are really cramming this upper extremity stuff in at the last minute! So, because we took two casts on two different patients...we then have to make two different sockets. The point of this is that one socket is going to be the hook socket and for the other socket, we are going to make a myoelectric arm (one that is operated by sensors attached to the muscles in the arm).
Alas, just when I was patting myself on the back (with my freshly created arm), I had to smooth up my second arm and get it pulled and ready by the end of the day. Luckily, a longer trans-radial amputation is much easier to modify so this one did only actually take about half an hour. I was able to smooth it out and get the socket pulled before they turned the lights out on us for the day. We have a couple of more days to get the second socket cut out and smoothed before the myoelectric fittings...phew.
As always, my biggest concern for the prosthetic fitting (for my first arm - with the hook) is that it will not even go onto the limb. As I mentioned in the last blog, upper extremity is all about exact fit so without that, I might be in trouble. I know I can get the hook working and the harnessing attached correctly and comfortably so I am focusing on getting my patient into the socket and then going from there. Here is to another successful fitting, happy patient and high marks in critique!
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