Oh, My(o)!!

Typical of life in the world of prosthetics...just when I think that upper extremity is not my cup of tea and does not have quite the "wow factor" that making legs does...I get to put on my myoelectric arm!!  This is like creating a robot (and I tried that when I was in 3rd grade and it was completely unsuccessful).  My myo arm, on the other hand, worked beautifully.  It was like watching living art.  Okay, I know I am being a little dramatic here, but it was really amazing - and gave me the same rush as seeing someone walk in a leg that I have made.

I had a model patient (not to be confused with a patient model - which he was also).  He has used myoelectric arms in the past (this obviously helped because he was well schooled in isolating his muscle groups and using the right ones to open and close the hand), but he does not wear one now - he prefers his hook.  I have to brag on myself for a moment because he did say that this was the best total fitting, total contact socket he had ever had.  Hooray, self-congratulatory pats on the back...all of that :)  I am allowed to brag about the best fitting comment because after wearing the arm for about half an hour and moving around, it began to fit a little too well.  Meaning, we could not get the thing off.  This is not a joke.  We were pouring powder down into the socket, using lotion - it would not come off.  I began sweating (bad day to wear a cashmere sweater) and was completely panicked that this poor man was going to have to have my socket cut off his arm.  I was worried that it was hurting him and I have to be honest, the student in me was a little worried about the future of my grade if we did not solve this problem.  My professor eventually spotted my panicked stricken face and saw three of us tugging on the arm and came up with a magic solution.  Air!!  Myoelectric sockets have holes drilled into the bottom in order to pull the patient into them (because they are supposed to fit so snugly), so he placed a tube into the hole and blew air in it so it popped off.  Phew.  I was so relieved.  So, the obvious good new is that the socket did come off my patient, the bad news is that when it got stuck it was just in the time period in which we were fitting the sockets - I still had to present my arm to the class for critique!  I was not really ecstatic about the idea of putting the arm back on my patient, but he was a good sport and figured if we had to resort to the air to get it off again, it was not the end of the world.  The school must pay these patient models a decent amount of money ;)

This is me shaking my patient's hand...my face does not look quite so polite because this was before we had given him a lot of practice and this was more of a hand crushing than a hand shaking.  After wearing the arm for 10 minutes, he was picking up his coffee in a plastic cup and easily drinking it and putting it back down.  He was able to control the speed at which he opened and closed the hand and the amount of force he used when grasping an object.  Like I said, pretty amazing.  It was just a really exciting day - moreso than I had imagined.  I could not believe that by making this socket and implanting two little sensors and screwing on a hand - fairly simple tasks - the end result would be so awe inspiring.  Granted, I did not create the actual hand and the fancy technology to go with it, I just helped implement it, but that was enough to end my semester on a really high note.

Yes, you read correctly...I said end the semester.  This was officially the last project of the semester and it was actually my highest scoring project yet!  I guess that is the whole goal, right?  Continue to improve - makes sense that I should be getting the best grades when I have the most "experience."  

So, we rushed through upper extremity...got a crash course and now we will be rigorously tested to see what knowledge we have retained.  Next on the agenda is two full days of finals - I believe 8 tests in all.  We will be tested on everything from the entire course - all the way back to transtibial (which is a little scary because I am not sure I remember a thing)!  After the two days of testing...provided they go well...I graduate.  Then they send me out into the real world.  Okay, thankfully for me, I am coming back to do the orthotics program in the Spring so I get to avoid the real world for at least another few months :)  Next time I post, it should be about graduation - so if I do not resurface, it is because the finals were too overwhelming and I decided to move to the Caribbean and be a bar tender.  Maybe if I get tired of studying I will watch Tom Cruise in Cocktail and work on my bottle spinning moves...

Getting Hooked on Upper Extremity

Well, when we started working on arms, all I could think was - I am running a "leg only" clinic!!  I just keep getting comfortable with one part of the body and having the tables turned on me and the feeling of helplessness makes me want to run back to what I know...which is a whole 13 weeks of lower extremities :)

Onto the important stuff - the fitting of my arm prosthesis.  My biggest fear in these fittings became my biggest reality...my socket would not go on my patient's arm.  Not even with lotion and coaxing.  I thought I was going to have to bag this project and chalk it up to a rookie mistake and hope for a better result next time.  Oh, no no no, not in prosthetic school...we are "failing forward" and there is no chalking anything up and turning the page.  There is only figuring it out in the following four hours!!  

So, that is what I did.  I heated up my socket, I flared it out, I trimmed it down and I magically got it on my patient.  Phew, one thing down.  It was not easy and not quick, but it had to happen in order to keep moving forward with my fitting.  I was so relieved when my patient was able to get this arm on that I was not too worried about operating the hook and working out the harness fit.  

The harness is easily adjustable so that was no big deal, the hook and cable and all of that was another source of drama and stress for the day.  I was cutting my cable over and over to get it the right length...repositioning my hook and adding rubber bands.  Long story short - it took a LOT of work, but at the end of the four hour fitting, my patient was able to wear the prosthesis and fully operate the hook to complete all the tasks required by my professor's check-out standards.  I was then able to chalk this one up to a successful project...and that made me very happy and very relieved.  Maybe upper extremity isn't so awful :)

As always, the day is never short and our reward for completing a project is the introduction to our next project.  In upper extremity, our next project is to create a myoelectric arm.  This was the second cast and mold that I worked on the day after finishing my arm with the hook.  The myoelectric arm is the one that is controlled by sensors on the muscles of forearm of the patient - these sensors are used to open or close or rotate a hand/hook.  

So, our afternoon was spent learning the ins and outs of myoelectrics that we will be fitting our patients with in the morning.  We learned the computer programs that go with the sensors and how to use the sensors and find the exact right muscle spots to get the most out of the sensors.  We actually got to put them on our own arms and hold the myoelectric hands in our hands and operate them - opening and closing - to see what our patients would be experiencing.  Per usual, I love the real life application that we were given in getting to use the sensors.  It is much harder than you think to control only one muscle group at a time.  In order for the sensors to work best, you have to flex with one group to close the hand and extend an other muscle group to open the hand - working on this control and fine tuning it to open slowly or close halfway is really difficult.  Most of the time, patients are sent home with sensors and computer programs that include games in order to get their muscles used to functioning the right way so the will be able to get the most out of their future myoelectric device.  

I was staring at this suitcase full of hands all during the lecture...it was a little creepy so I thought I would share :)

Tomorrow we fit our myoelectric sockets and then hopefully get our patients working on the sensors and able to make these arms fully functional!!

Fun with Foam!

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!

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!

There's No Time...There's Never Any Time!!

School is winding down and it is insane!!  This has been one of, if not, the longest weeks of the semester...we have done upper extremity all week and it has been an exhausting whirlwind!!  I have to give a research presentation tomorrow and am in the middle of creating my PowerPoint for it, but I thought I would post a few fun pictures from the last few weeks...just so you do not think I have quit school and taken up a career elsewhere :)

Representing for the Symbionic leg on a patient visit day - we actually did not even plan this, but I thought it looked adorable!

No forewarning class picture at the end of a super long day of patient visits and critiques...I wish I would have known, I would have put on mascara or something :)

Me, Horace and Erin during a photo shoot for Cal State's website about the O&P program...natural models.