Movin' on Up

We have closed the chapter on legs and have moved above the waist to upper extremities...aka, arms!  Upper extremity prosthetics is a whole different ballgame - when making legs, it is all about function (comfort plays a big role, of course, but you want to get the person up and walking).  In upper extremity prosthetics, it is more of form over function.  The majority of people with upper limb deficiencies have already adapted their lives to accommodate for whatever their limb difference might be, and most choose not to even wear a prosthesis.  Upper extremity has not come as far as lower extremity, so with hooks being one of the best options, many users choose to wear nothing instead.  If someone chooses to wear an arm prosthesis, a lot of times, it is for cosmetic reasons - this is where you have to get the form of the prosthetic device just right.

So, like the beginning of every other new topic, we used ourselves and each other as patients.  We casted as though we were casting someone with a wrist disarticulation - essentially, someone who has just lost only their hand.  It is strange, but this casting was a little trickier to get just right...moreso than the legs were the first time.  We also had to use splinting methods, as opposed to wrapping, and that made it hard to capture the volume and all of the anatomical landmarks.  A lot of prosthetic arms are self-suspending so it is really important to get the fit just perfect.  A lot of them also involve wearing a harness (as you see in the pictures) and that is a second form of suspension if it does not suspend on its own via the skin or a liner.  Horace made a lovely cast of my arm and created a comfortable socket for me to wear around school.  It probably helped that I was a model patient :)


It is always interesting to be put in the patient's shoes - such a different perspective in the casting.  As a practitioner, I am constantly feeling rushed and like the plaster is setting off and getting hard too quickly.  I am hurrying to get it all done before it is too late, but as a patient, it seems as though you have to hold this position forever before the plaster turns into the hard cast.  Trying not to move to help out your practitioner is a little stressful...something important for me to remember in the future!


Horace was an equally great patient - if only his arms were not so darn big :)  I made it easy on him, he only had to make the tiniest little cast ever.  I was struggling to get my hands around both of the splits and hold the whole thing in place on his arm.  There are all of the rules about getting the elbow in and making sure it can bend and going over epicondyles...I felt as though I did a pretty decent job for my first ever arm casting, but like I said, it was surprisingly more difficult than I had imagined.


The last half of the day, we were fitting each other for modified arm prostheses.  I mentioned that a lot of them involve wearing a harness and this hook is the very reason why.  It is attached to a cable system that is activated to open and close by elevating or rotating your shoulders.  The harness system allows for pulling to occur and the cable to pull back on the hook and open or close it.  Getting to wear this was like when we put on the walking boot and got to experience what walking on a prosthetic foot feels like.  I love when the school is able to make this really applicable and give me a chance to feel first hand (in a small way), what it is like to have a limb difference.  I know that when you live with this harness and hook system it becomes second nature and patients do not have to even think about operating them, but we were attempting to do normal things (unbutton your jeans, pick up a water bottle, get keys out of a purse) and it was tough!!  We also had to be able to get ourselves in and out of the harness with one arm on our own...this involves some contouring and acrobatics for sure!!

All in all, our first day in upper extremity went really well - I learned a lot and it was super jam packed, but this is something I really know very little about (and have seen very little in the field) so I am glad to be learning it and glad to be getting some hands on experience.  We will cast our patients and make them the same type of hook and harness device - from scratch - and hopefully all of the pieces and parts come together to make a working arm!