Listen: Apple | Spotify | YouTube
Full Course Details: Public course page
Learn more about our guest: Haley Van Escobar, MOTR/L, CHT
Materials shared by Haley
Example Letter of Medical Necessity.pdf (1.1 MB)
Finger Prosthetic Case Report.pdf (1.2 MB)
Type of Prosthetic Designs_NP.pdf (363.5 KB)
Finger and Partial-Hand Amputee Peer + Support Group – Facebook
Prosthetic Reimbursement Literature & More– Naked Prosthetics
Agenda
Intro (5 minutes)
Breakdown and analysis of journal article (5 minutes)
- 00:00:00 Intro
- 00:00:55 OT Potential Podcast Intro
- 00:02:29 Introduction to digital prosthetics
- 00:03:00 Determining what is important to the individual user
- 00:04:07 Intent of the research
- 00:04:33 Methods
- 00:05:14 Findings and Discussion
- 00:08:56 Discussion and Conclusion
Discussion on practical implications for OTs (50 minutes)
- 00:09:42 Intro to Haley Van Escobar
- 00:12:44 How Haley came to work with a digital prosthetics company
- 00:20:07 Haley’s current work
- 00:22:27 Article impressions
- 00:27:21 What is changing in digital prosthetics?
- 00:37:38 Navigating the emotions of a hand injury and prosthetic wearing
- 00:45:49 Who is a good candidate for a finger prosthetic?
- 00:50:46 What is the next step when an OT encounters a good candidate?
- 00:56:12 What are the most important things OTs can do to help adjust to a new prosthetic?
- 01:02:22 Biggest challenges in OT and prosthetics & how do we rise up to meet them?
Supplemental Research
- A systematic review in prosthetics and orthotics education research
- Team Approach to Prosthetic Prescription Decision-Making
Article Review
Read Full Text: User experiences of digital prostheses in daily functioning in people with an amputation of thumb or finger
Journal: Journal of Hand Therapy
Year Published: 2022
The art and science of finger prosthetics is advancing rapidly.
Yet, many people with amputated fingers do not wear a prosthetic.
We, as healthcare providers, may be partially at fault due to our own outdated assumptions of poor outcomes and limited options for digital prosthetics.
Today, we’ll look at a research article exploring the experiences of people who wear digital prosthetics. Our goal is to help you listen more closely to your own clients and their needs in this area.
Next week on the podcast, we’ll welcome Haley Van Escobar, who owns a hand therapy private practice in addition to working for a digital prosthetic company. You’ll learn how she landed that job—and what OT professionals needs to know about this quickly evolving space.
Let’s dive in.
Introduction to digital prosthetics
Following amputation, a digital prosthetic can help improve:
- Grip
- Strength
- Manipulation of objects
- Body image
Digital and partial hand amputations appear in many variations, necessitating unique consideration for each case. Above all, it is critical to know which activities that have been impacted by the amputation are the most important to the individual receiving care.
Determining what is important to the individual user
Unfortunately, past research has shown a lack of agreement between users and professionals on the objectives of wearing a prosthetic.
Specifically, this research showed that upper limb prosthetic users considered function to be the most important objective, followed by comfort and cosmetics.
By contrast, prosthetics professionals considered comfort to be the most important objective.
Given these past discrepancies and the variety of options that have been made available in more recent years, it is crucial for professionals to anticipate and consider user experiences in order to achieve the best functional outcomes for each individual. Unfortunately, when looking at the research, very few studies focus on the use of digital prosthetics—period. And, none focus specifically on the user’s experience. Which is where this study comes in…
What was the intent of this research?
The true value of a prosthetic can only be assessed by the user themselves.
Thus, detailed knowledge about the user experience is invaluable to any professional’s ability to give informed advice about prosthetics. This study aims to shed light on digital prosthetic user experiences with respect to daily functioning.
What were their methods?
This study used a qualitative descriptive method with a phenomenological approach. A phenomenological approach involves studying lived experiences to gain deeper insights into how people understand those experiences.
Data collection and analysis
Semi-structured one-to-one interviews were used to collect data for the study.
Lasting 45–60 minutes each, these interviews were conducted at a rehab department in the Netherlands between 2017 and 2018. Audio recordings were transcribed. They were then analyzed using the 6 steps of Interpretive Phenomenological Analysis.
Findings and discussion
A total of 4 people participated in the interviews. Of these participants:
- 3 did not have thumbs.
- 1 was missing their middle and index fingers.
- 2 had amputations due to animal bites.
- 2 had amputations due to industrial accidents.
- 3 had worn different types of prostheses.
Three overarching themes were identified from the interviews:
1. Regaining “grip” on life
This theme centered on how the prosthetic improved the user’s quality of life. It was divided into three sub-themes:
Self-esteem
The prosthetic was an important support in the user’s efforts to carry out activities independently, contributing to their self-esteem. For two participants, the prosthetic also positively impacted their body image by making them feel complete.
Recognition and respect
The participants wanted recognition of their loss and suffering, as well as respect for making their best effort.
Restoring roles and independence
Two participants felt the prosthesis helped them restore their role in relationships. Three felt the prosthesis was crucial to their ability to perform their work.
All participants felt the prosthetic was important to restoring a sense of independence. However, it is important to note that while the prosthetic was supportive in this, the users still perceived their current experience as suboptimal compared to their experience prior to amputation.
2. Load balancing
Past research has shown that musculoskeletal complaints on the contralateral side are common following upper extremity amputations, due to unevening distributed lows.
Participants in this study echoed these findings, reporting that before they started using their prosthetic, the physical overload on their unaffected hand had led to serious complaints. For one participant, this problem almost disappeared after she started using a prosthetic.
On a related note, three participants articulated that the grip enabled by their prosthetic made them feel safer when performing potentially dangerous activities. For example, one participant highlighted being able to grip the railing when carrying groceries up the stairs.
3. Assessing technical aspects of the prosthetic
Another theme from the interviews centered on the limitations and benefits of the prosthetic’s material and technical characteristics.
All participants started with a silicone prosthetic. These have the benefit of appearing similar to a finger. (Here’s a website I found that showcases this.) But, silicone prosthetics often cannot extend or flex like a finger, which discouraged two participants from using them at work.
One participant valued the lifelike appearance of the silicone prosthetic so much that she did not leave the house without it. She accepted that it needed to be replaced every few years due to wear on the materials. She also avoided contact with substances like chlorine that could damage it.
One participant went on to try a passive (non-moveable) thumb made of stiffer materials than silicone so he could exert more force in his grip.
Two participants went on to try an active digital prosthetic. This had the benefit of greater mobility, but it came with limitations in range of motion and exertion of force. It also needed to be protected from moisture.
Again, none of the participants felt that their prosthesis completely replaced their lost fingers, and adaptation to either the activity or the environment was often still necessary.
Discussion and conclusion
The main finding of this research was that digital prosthetics were perceived as important for people with amputations to perform tasks and participate in activities independently.
The prosthetic meant something different to each participant, and this study highlights the importance of identifying the individual requirements each prosthetic must meet—and being aware that the individual’s needs may change over time.
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