The paper, written by C.M. Fraser, states:
"There is currently a distinction drawn between a prosthesis
considered to be provided for purely cosmetic reasons and a functional
prosthesis provided to enable the amputee to achieve basic hand
function. Using video analysis the study demonstrates that for
non-manipulative actions cosmetic prostheses are actively used in the
performance of everyday tasks as frequently as functional prostheses.
The study provides evidence for a cosmetic prosthesis to be presented
to an amputee as a realistic initial prosthesis and not as the option
of last resort if a functional prosthesis is rejected. It is also
recommended that training is provided in the use of cosmetic
prostheses in two-handed tasks."
For case managers, there are a number of important issues to be
examined.
First, you need to discard any preconceived notions of what
constitutes a
"successful prosthesis user." Sometimes, amputees themselves, have a
poor
understanding of whether they are a good user or not. People with
hands or
hooks that were functional (those which could open and close) and that
were
passive (those which could not) were asked to participate. Amputees
with
passive prostheses tended to report that they were not good users.
This was
congruent with several past studies in which amputees with similar
prostheses
would fill out surveys stating they didn't use their passive hands.
What is
so remarkable about this new study is that the researchers didn't rely
on
self-reporting alone. They went to the homes of the amputees and
videotaped
them performing prescribed tasks (making and serving a hot beverage,
buttering and slicing a piece of toast, writing on a piece of paper,
sealing
it into an envelope and then removing it from the envelope). What the
researchers found was a surprise: "there was no significant difference
between the groups in relation to the number of actions made for
non-manipulative descriptors." In other words, actions like
supporting,
stabilizing, pushing or balancing were executed as often by people
with
passive prostheses as by those with functional prostheses.
These findings do not diminish the other findings of the study, that
amputees
with functional hands or hooks do use the grasping capabilities of
their
prostheses. What the findings emphasize is the definition of
"functional"
and the importance of appearance. "Functional" should not simply
describe a
prosthesis which an amputee can use to grasp an object. That
definition
ignores the majority of tasks for which the prosthesis is actually
used.
Tasks, such as holding an object up or down, pushing or pulling an
object
closer, wedging an object between the prosthesis and the wearer's
body, are
more frequently performed by the prosthesis. Period. Even when an
amputee
has a prosthesis that provides active grasp, they will use their sound
hand
first. Their prosthesis is used as an assistive device, not as a
primary
device.
If the amputee does not like the appearance of their prosthesis, they
will
probably not wear it. Thus, whether it is a "functional" or passive
prosthesis, it will not be available to assist them with activities.
This is
important to consider when you are involved in the care of an amputee.
If
you advise that a prosthesis be delivered based on "functional needs"
only,
which many consider to be the ability to grasp, then you have
overlooked the
majority of activities for which the prosthesis will actually be used.
However, if you take into consideration the fact that many amputees
will want
an artificial arm that looks more like a real arm, then you will be
providing
them with a tool they will wear and use.
I have been an arm amputee all my life and worked with other arm
amputees for
the last ten years. I have heard many amputees say they didn't think
they
were vain until they lost their arm. They believe that because they
only
want to wear a prosthesis that looks like the hand they lost, that
they are
somehow requesting a luxury item. I believe just the opposite. Vanity
is
associated with seeking attention. Wanting a natural looking
prosthesis is
wanting a prosthesis that will cause fewer people to take notice.
Therapy is another important issue discussed in the paper which can be
used
as a tool to better rehabilitate your clients. Talk to therapists
about the
activities which they will ask their clients to engage in. C.M. Fraser
writes:
"In training amputees to use their prostheses they are frequently
encouraged to practice picking up small objects with their TDs. The
unilateral amputee may well demonstrate a high level of skill in the
performance of these tasks in the clinic situation but is more likely
to use his intact hand to execute these tasks in everyday life..... If
the role of the prostheses in supporting, stabilising, pushing,
pulling, holding and facilitating balance in every day life situations
is accepted as more useful than that of manipulating small objects in
the clinic situation; this could have a major influence on the design
of prostheses and TDs and also influence training."
Suggest to the therapist that they work with the amputee in the tasks
mention ed above (such as supporting, stabilising, etc.). I remember
when I was
little, methodologies in training required me to complete a list of
things I
had never done before and don't believe I have ever done since. I
realize
some of these were necessary to help me master control of the
prosthesis.
However, it was thirty years later when an occupational therapist
showed me I
could stabilize (not grasp and crush) a banana with my prosthesis.
Then, in
my sound hand, I could hold a knife to start peeling the banana open.
Before
that, much to my dentists' dismay, I had always used my teeth.
As a case manager, you have a wonderful opportunity to advocate for
your
clients who are arm amputees. You can facilitate the coordination and
education of the health care team, eliminate false notions (that
amputees may
have of their own use patterns) and encourage therapists, prosthetists
and
physicians to provide training in a wide range of activities
including, but
not limited to, grasp.
Again, as quoted earlier;
"The study provides evidence for a cosmetic prosthesis to be presented
to
an amputee as a realistic initial prosthesis and not as the option of
last
resort."
| Func-tion-al
(fungk’ she nel) adj. 1. Of or relating
to a function. 2. Designed for or adapted to a particular
function or use: functional architecture. 3.
Capable of performing; operative: a functional set of brakes. |
If we correctly apply
the above definition to the field of prosthetics, a functional
prosthesis would allow the user to perform a desired function or task.
Historically,
prostheses were considered functional if they enabled individuals to
perform physical tasks or permit the body to move effectively.
Fortunately, we have come to recognize the diverse and often complex
needs amputees have in our modern world. Educated health care
professionals now understand that function is a relative term and
therefore true function is contingent upon the specific needs of each
individual patient.
The following
categories delineate the different types of prosthetic function now
recognized in the field of rehabilitation medicine. These categories
will be extremely helpful to the new and mature amputee alike. For the
new amputee these categories can help make sense of the complex
experience of limb loss. For the experienced amputee they can give
fresh insights into what needs may or may not have been met by the
prosthesis they are currently using.
1)
ACTIVE FUNCTION: Function which mimics or enables the
body to perform a task by employing the prosthesis (i.e.
hook, myoelectric and body powered prostheses, leg and feet
prostheses, many partial hand prostheses and even many finger
prostheses).
2)
PASSIVE FUNCTION: Function which enables the prosthetically
restored limb to accomplish tasks more effectively but does not enable
the limb or body to actively articulate or maneuver (i.e. passively
made arms and hands, partial hands, finger and toe prostheses).
3)
EMOTIONAL FUNCTION: Function which enables amputees to
overcome the emotional trauma associated with limb deficiency. This
function has been previously overlooked but is now being recognized by
the health care community. Almost all prostheses are capable of
meeting this need. However, if this need is specifically based upon
the desire for an aesthetic restoration, then only a lifelike
prosthesis such as LIVINGSKIN®
will suffice.
4) ECONOMIC
FUNCTION: Function which opens the door to opportunities
that may actually be, or appear to be, closed to amputees. Most
prostheses in the five functional categories are capable of fulfilling
this need. Prostheses that allow the operation of a machine lever, a
keyboard or vehicle clutch, or that allow the wearer to conduct an
interview, make a presentation, or perform a dance piece, fulfill this
function. LIVINGSKIN®
prostheses have been successfully made to allow amputees to do all of
these things with confidence.
5)
SOCIAL FUNCTION: Function which enables amputees to
develop a rewarding and satisfying social life. In the past this
function has been underemphasized and misunderstood. However, the
importance of this critical function has been acknowledged as the
consciousness of educators, physicians, social and behavioral
scientists has been raised in their respective fields. Because LIVINGSKIN®
prostheses appear so lifelike and natural, they add a level of comfort
that only LIVINGSKIN®
can provide.
In the subsequent LIVINGSKIN®
categories, you will find all five of these functions represented.
Because the needs of each amputee are unique, it is important that the
LIVINGSKIN®
prosthesis you choose, or choose to recommend to a family member or
patient, meet their specific functional requirements.
