It's All in the Wrist

I really have to start taking better "before" pictures so you can really appreciate how much work went into what you are currently looking at in this stage of making this orthosis.  This next project is a wrist driven orthosis - a ratchet design that is never used anymore, but operates by using wrist extension (bending your wrist back) to cause the first two fingers and thumb to make a pinching motion.  When the wrist is relaxed from extension into flexion, the fingers open and the pinching grasp releases.  This is great for someone who still has the extensor muscles present in their forearm, but cannot fully use their fingers.  It allows them to pick up objects, grasp things, and even write.

We were given a bag full of pieces of straight metal and a lot of rivets and screws and expected to create this device.  So, what you are looking at in the above picture is about 10 hours of metal bending work at its finest :)  The two big metal pieces were both straight and had to be bent and fit to my patient.  They had to be cut and trimmed down and smoothed - it was a very long process...made even longer by having to share the machines with 16 other people.

After getting these two pieces bent correctly and attached to each other, I then had to create the finger pieces for the brace.  Originally, looking at the finger pieces, this did not seem like it was going to be a huge obstacle.  Wrong!!  The first part of the finger pieces is bending three tiny metal strips to circle around the top half of the fingers.  I thought bending metal around a forearm was super tough.  Bending metal around the width of two fingers is brutal!  It is a very tedious task to try and make these tiny, tight bends.  The finger piece of the wrist driven orthosis has to be just right in order to keep the device on and functioning and comfortable.

This is what the finger piece looks like when it is all said and done.  Tiny bent metal and a tiny bent rod holding it all together.  This piece was made for my partner so it does not fit exactly right on me, but it shows what I spent 4 hours creating.  The metal bending was the tricky part, but then we got to solder the metal to hold it all together and that was very exciting!  And very scary!  I have become accustomed to using blow torches at school, but not in this way!  We typically just use them to get some plastic warm and mold it a little bit, not to melt silver and drip it onto metal in order to fuse it together.  This was my first time soldering and although I got the hang of it rather quickly, it was quite intense and (on par with all the new things I am learning at school) somewhat stressful.

But let's be honest, I look pretty cool wielding a torch and obviously it brings a smile to my face.  Fine, I will give soldering another chance!  Melting things is typically frowned upon so it was fun to be told that this was part of the process.

I was able to get the finger piece completed and walk away from the wrist driven device for the day.  Staring at pieces of bendable metal for 9 hours in one day really just makes you want to throw it out the window.  I cannot believe this project still has two more days of fabrication before it will be done!!  No wonder they do not make these in practice anymore, it is not practical to have to spend 25 hours working on one orthotic device.  That, and it looks like it came out of the stone ages!!  No one wants to wear a purely metal contraption on their arm...well, maybe not no one, but I know for me it does not work with my gold jewelry :)

A Quick Fix

Okay, I have a confession to make - the hours of the Orthotics program at school are much less than they were in Prosthetics...logically, you would think that this means I would have much more time to blog - except I seem to just get wrapped up in doing more of nothing when I have nothing to do.  So, I am obviously behind and we have moved on past the upper limb orthotics, but I am going to continue to update in the order of our projects thus far in the semester.

Last post was working on my specific diagnosis of making a brace for a classmate who had "severed his tendon of the flexor digitorum superficialis."  I got pretty far in making the brace the first day so all I had to do was smooth up the trimlines and attach the straps.  I am happy (and very proud) to report that I sewed my straps with very little stress.  They do not look perfect, but they are much improved!!  The projects we are doing right now are basically for knowledge of how to do something, not necessarily to create a perfect final project.  We are riveting a lot of things on just for quickness of completion - not the way it would be done in practice.

After sewing the straps and riveting them on the brace, the project was complete!  I fit it on my patient and it kept his hand and wrist in a neutral position, doing its job in keeping the tendon from being able to move, therefore giving it time to heal.

Not much to look at, but it was a pretty simple diagnosis and that makes for a pretty simple and straightforward brace.  We had a couple of hours to finish up our projects in the morning and then went straight into critique in the afternoon.  My critique went well and I was happy and relieved to know that I had created an appropriate brace for the diagnosis I was given.  I love the "real life" aspect of being given a diagnosis and no solution and no direction for a brace and being able to use what I have learned and research in order to create what I think is the right thing.  It is a great learning experience and makes school feel so much more applicable.

Here I am modeling the brace that was made for me by a classmate.  The diagnosis going with my brace was ulnar nerve palsy - meaning the nerve that runs down the side where the pinky finger is affected in some way.  This causes the hand to form a "claw" and affects your ability to perform small hand motor function movements.  The brace that my partner made for me kept the hand in the claw position in order to accommodate for the ulnar nerve being affected and potentially painful, but left the thumb and ring finger and pinky finger free in order to allow some movement and some function of the hand.

We have one more upper extremity project and apparently it is the worst one ever!  We are going to be making a wrist driven device - it is a big metal contraption that apparently is never used anymore in practice.  My professor who is in his 60s said that during his 30 year career he only made one.  We were told we will be making them as sort of a 'rite of passage' into the world of orthotics.  I, personally, would not be offended to not make that journey, but it looks like my grade depends on it.  Next up, more metal bending and and ancient wrist hand orthoses :)