Moving on From Metal

We finally got a small reprieve from all of the metal bending and were able to design plastic wrist hand orthoses today.  Creating a plastic molded device means first creating the mold...I think it is easy to see where this is going...back to the world of plaster molds!!  Casting a patient and then using the cast to create the mold that then becomes the form to vacuum plastic around for the device.

To the left, you can see the bits and pieces that make up my cast of the forearm, fingers, and thumb.  In orthotics, because it is focusing on correcting limbs rather than supplementing for not having a limb, we mainly use each other as patients.  For this assignment, we were each given a classmate partner and a random diagnosis to create a custom WHO around.  I loved that everyone had a different pathology to work from because it meant there were 17 different projects in the class and it gave everyone a chance to research their own diagnosis and have to use what we are learning to decide what type of orthotic device would be necessary for that diagnosis.

My patient sits caddy-corner to me in the workroom and the diagnosis I was given was a "tendon laceration of the flexor digitorum superficialis."  Yes, it sounds fancy and too many words for what the simple, watered-down version actually is...a suicide attempt by slitting the wrist.  How pleasant, right??

So, after researching, I learned that the brace needed for a cut tendon is one that keeps the tendon immobile and gives it time to rest in order to heal.  The flexor digitorum superficialis goes down from the wrist into the fingers and is what would help you wave "bye-bye" if you were a toddler.  It curls the fingers down.  In order to keep this tendon from moving, my job was to make an orthotic brace that held the forearm and the fingers in one position - one where they could not be flexed or extended.  The nice part about creating orthotics is that the casting and modifying goes much quicker than it does in prosthetics.  Because I was creating a brace that was only going to go on the wrist and palmar side of hand and it was a device that was just going to fit on the patient's current forearm/hand, all I had to do in modification was smooth up my cast to get it ready for the plastic.  I was also able to cut my thumb portion off because the thumb is not moved by the tendon that was injured in my diagnosis and therefore does not have to be included in the brace.  My patient is not able to move a single one of his fingers, but he can let his thumb go wild!

Vacuum forming plastic is exactly the same as it was in prosthetics - simply drape the melted plastic sheet over the mold and turn on the vacuum switch to get it to mold to the cast.  It also still makes me equally panicky as it did in prosthetics.  I am getting better at handling the flimsy burning hot, drooping plastic square from the oven, but I still get anxious about the timing of it all and getting it right on the first try.  Luckily, I got this one right on and had the flexibility of knowing I was cutting off the entire back portion of this brace so putting a seam in it or a wrinkle in the back was not going to ruin the project.  Phew :)

And this is what my WHO looked like by the end of the day.  Like I said, it goes much faster in orthotics so I was able to get from the casting point to this point in one day - completely unheard of when I was working on a leg in prosthetics!!  This device is not made for me (as you can tell it is much too big in the picture), but this way you can get an idea as to where I am going with the project.  It keeps the patients fingers in a relaxed position and the forearm supported.  It provides total contact on the affected side and also can easily be removed for hygienic purposes.  Up next is to smooth out the plastic around all of the edges, fit it on my patient and make sure the trim lines are in the right place and then to sew and attach the velcro straps.  As you can tell by my filthy and cluttered workbench, this was a good stopping point for the day - it was a long time in the lab and I need the rest to gear up for attempting to make nice with the sewing machine for my straps.  A completed plastic WHO and a critique to immediately follow are up next on the agenda.  Stay tuned...

WHOs and HOs

Orthotics has officially begun!!  My career in custom bracing has started out with bending metal and making a HO.  You read correctly...we actually made a device called a HO.  It stands for hand orthosis, but everyone seems to prefer the shortened version.  It makes for amusing lectures with immature responses from the class.

It looks like nothing, right?  Such a small device that took more sweat than seems necessary.  It is rather ugly, I recognize this - in fact, I was happy to throw it away after I was done.  This was a first day of school learning experience.  The only impressive part about this HO is that I really made the entire thing myself - bent the metal, sewed the straps, glued in the foam interface, and riveted the pieces all together.  Bending metal = no fun.  To get a straight piece of metal to wrap completely around someone's hand is time consuming and much harder than it looks.  I think the idea is to be able to make one of these in about half an hour, but this was a two afternoon project in the world of first timers.  The only reason a person would really need this device would be if they needed to hold their thumb is this position.  Most hand orthoses come with a wrist portion attached - this would be the major reason to put a crazy metal contraption onto someone's hand.  Which, of course, in a lovely segue - leads me to our second project of orthotic school...the WHO!!

Hopefully your deductive reasoning skills have kicked in and you have figured out that a WHO is a wrist hand orthosis.  This is me modeling the one that my partner made for me.  We actually used our previously made HOs and then just added the forearm and wrist components to make this lovely brace.  I think having a great manicure and the party nail really jazzes up the hunk of metal attached to my hand.  Thankfully, off the shelf bracing has come a long way and this is the old school way to make a wrist and hand brace - I cannot imagine that many people would be thrilled about having to wear this in their every day life.  Also, I might add that it is slightly dangerous - I would forget which hand I had it on and go up to brush my hair out of my eyes and a piece of hard metal would poke me in the face.  This was, per typical school protocol, just another learning experience.  We are trying to get practice bending metal and sewing straps.  Bending metal is still something I could take or leave, but I am happy to report that I am no longer scared of the pedal on the sewing machine.  We have found a nice rhythm and seemed to get along this week.  My velcro straps were top notch :)

I am also happy to say that the orthotics portion of school is going swimmingly.  The pace seems much slower than that of prosthetics, but it is hard to say if it is actually slower or if I am just adapting to a learning environment that moves so quickly.  We seems to have more time to fabricate our devices...again, not sure if this is actually meaning more hours to accomplish something or that having completed the prosthetics program, I am actually fabricating things more quickly.  The most interesting part of orthotics and bracing to me is that you have to really learn all of the pathologies that come along with the need for orthotic intervention in order to really make a great device.  We have pathology lectures multiple times a week and I have really been enjoying learning the ins and outs of what a stroke can do to cause a person to need an orthosis; what happens when a person suffers from a traumatic brain injury and what type of interventions can be used in their recovery.

I think that prosthetics has my heart, but I am really going to continue giving orthotics a chance.  It does not have the same pizazz as making someone a leg and watching them walk for the first time, but to put it in perspective makes me realize that making a back brace for someone who has been suffering greatly from back pain and helping to relieve that is still a chance to help improve someone's quality of life...and that makes me smile.

I Graduated!!

It is done!!  Well, part one is done.  Graduation came and went - it was exciting and uneventful at the same time.  Graduating and knowing you are going right back into school makes it hard to feel as though graduation is the end to something.  I think when I graduate in May from the Orthotics program it will feel much more real, much more final...and rather than being an ending to all of my education, it will be a beginning to the start of a fantastic career in prosthetics and orthotics.  Orthotics blogs coming up...get ready to be enthralled in the world of custom bracing!!