MORE RESPONSES UCLA CAPP TD
Steven P. Chambers
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Collection
Title:
MORE RESPONSES UCLA CAPP TD
Creator:
Steven P. Chambers
Text:
Here are two more responses I received from my inquiry regarding the UCLA
CAPP TD.
Steven P. Chambers
Subj: RE: UCLA CAPP TD
Date: 3/2/00 5:45:37 PM Eastern Standard Time
From: <Email Address Redacted> (Wilson-Brown, David)
To: <Email Address Redacted>
Hi Steven,
Having worked in the paediatric Limb Deficiency Clinic at The Royal
Children's Hospital,Melbourne,Australia,for some 7 years in the 1990's, the
clinic team including myself seviced the prosthetic and orthotic needs for
almost all limb deficient children in SE Australia.
Our experience was that prior to the commencement of our myoelectric
prosthesis program, most trans radial/trans humeral kids were fitted with a
majority of CAPP td's and a small number of Hosmer 12P and 10P hooks. These
were prescribed as a matter of course but were found after a statistical
survey (presented ISPO World Congress, Melbourne 1995)that kids simply
didn't use thier prostheses actively for any meaningful grasping activities.
This was high-lighted by a 75% usage failure rate of all upper limb
prostheses prior to 1991. Of course, this high figure can't be soley blamed
on the lack of prehension power and cosmesis characteristics of the CAPP td
but these were significant factors.
In the same survey, the introduction of the myo programme reversed the poor
wearing rates of these kids. Approximately 73% of all children wearing
prosthesis actively used there myo's and a small number of the newly
introduced TRS Adept child td's.The cosmesis of the VASI and Bock electric
hands was welcomed by the wearers (and especially thier parents!) but it
really was these td's prehension power and abilities that made these
prostheses useful.
So Steven, to cut a long story short, in our experience, the CAPP td's(even
with the heaviest prehension springs) had poor prehension strength and
holding abilities (due to a very small 'thumb' surface area), was unpopular
cosmetically by both patients and parents and was therefor in a majority of
cases rejected.
I personally recommend the fitting of a 'crawling' mitt when the baby can
essentially sit unassisted, be fitted with an appropriate body powered hook
device when beginning to walk and perhaps be fitted with a larger hook, TRS
V/Closing td or preferably an electric prosthesis around 2-21/2 years of
age. I cannot emphasis the importance of proper initial and followup
prosthetic training and preiodic review by an experinced prosthetist and/or
a suitably trained therapist. This is the key.
If you want more information regarding paediatric prosthetic management,
there are a number of good books and articles published on the matter. You
might like to talk to Winifred Heim (Prosthetist)and Sheila Hubbard (Occ
Therapist)at The Bloorview McMillan Centre in Toronto. Very knowledgeable
people.
I hope this imformation helps you.
David Wilson-Brown.
(Prosthetist Orthotist)
Caulfield General Medical Centre,
Melbourne, Victoria, Australia.
Subj: Re: UCLA CAPP TD
Date: 3/2/00 3:29:38 PM Eastern Standard Time
From: <Email Address Redacted> (R. Okumura)
To: <Email Address Redacted>
On Thu, 2 Mar 2000 <Email Address Redacted> wrote:
> Our practice is basically geared toward adults, and we see very few
children,
yes, children are seen in a concentration in the children's hospitals and
then very sporadically through the general private practices. it is quite
unusual that you see so many UEP's in adults as they also generally
gravitate to one of the practices in an area and the other practices see
very few
> and even less upper limb amputee children.
even though this is probably the most common limb deficiency, the
handicap is the minimum as cosmesis is probably the greatest handicap
for the unilateral presentations. most do not wear prostheses in
adulthood.
>The child that I am most concerned
> about at the present time is 9. This child is quite happy with the CAPP and
> so are his parents.
i think this is the same phenomenon as the post-polio clients who want
metal KAFOs and do not switch to plastic. lots of it is i think the body
image they have formed. they do change if they get a different
prescription, at 9 they are still adaptable and can without so much
frustration learn the subtleties of a different shape for function.
>As you pointed out, the Kraton pads do wear out often.
> Also he quite often loses the thumb pad. I guess you have experienced all
of
> this.
yes, the thumb is locked in only by the two dots and it is easier to
fiddle with and pull off. it can only get lost if it gets pulled off. it
does not fall off during activites. as i mentioned, it is in the design
for the pads to wear as this increases the coefficient of friction. most
families don't report this as a problem. the thumbs wear out the most
because the kids us the end of the thumb to push buttons and the surface
area is small for the repetitive force. i replace more thumbs that palms.
> What is the upper age limit that a child is fitted with the CAPP? Are there
> any steadfast rules about this?
joann who replied to the list is a CAPP OT and speaks with the most
authority on what the age range is.
as far as steadfast rules, i don't practice with many of them as far as
TDs are concerned. in fact, i am the UEP instructor for out P & O
curriculum and i teach fitting to meet the needs of the client.
if your client can do all of the activities he chooses with this TD and he
does not mind the differential in size, who are we to tell him that this
is wrong? or doesn't look right? in reality anything other than being born
with that hand normally formed doesn't look right.
however, he is 9 and his needs will change. you might suggest to him,
them that he discuss with you what he does, how he uses it. are there some
activities that he does not do because he is not able to get assist
from his TD. and keep this an open ended discussion, that might include
not wearing one! there is often a lot of silence to the questions, but ask
based on what your kids do/did at 9 y.o. ask specifically: does he not
build models, climb the jungle gym, jump rope, play baseball, etc. using
your knowledge of bimanual activities and the grasping surfaces and pinch
forces required--ask the parents if they observe hesitation to play such
games. some kids are couch potatoes by nature and that's okay, but if it
is a choice because the prosthesis is not a good tool, then you can
suggest changes to try for one prosthesis, and you can always put the
capp back on anyway!
the good news is when you make a new prosthesis with the CAPP, and he
grows and he changes to a different TD, the size will lenthen the
prosthesis overall and it will not be so short.
>In your experience, what is the oldest
> patient you have seen who uses the CAPP?
my patients have shifted to something else around 6 or 7. after this age,
the activities they do in school do not require learning bimanual fine
motor skills, so they can function with other TDs quite easily. lots go
to hands, some go to ADEPTs and dorrance hooks with plastisol. look up
sheila hubbard's journal publications on functional requirements by age.
sorry i don't have the references. she is form toronto.
>Since the CAPP is smaller than most
> TD's I don't think that it would be useful for a teen or an adult. Maybe
you
> can enlighten me on this.
these kids do not NEED a prosthesis for ADL if they are unilateral. most
do perfectly well without one and most do not wear one and are great
members of society, if you don't believe me go to the I CAN website.
many believe that wearing any kind of a prosthesis is a hinderance. :)
have you ever tried to wear one for a day or two? it distracts you
from your task because you have to do so much planning to get it to work
well.
my biggest reason for fitting children is that they easily learn how they
work and it is like riding a bike. they may stop wearing one, but if they
find a need to use one as an adult, they put one on and can use it.
trying to learn as an adult though is an arduous task.
remember that the TD is only another tool. and sometimes you need a small
screwdriver and sometimes a larger one works. for example, i have an adult
client who has an 8 1\2 myo hand prosthesis, a 7 body powered prosthesis
and a socket with a flexion wrist and a 10X right on the end so he can
weld. form follows function, so as i teach my students, you need once in
a while to get out of the box and advocate for what you client wants and
not be one of the normal people trying to make them normal too, because
every one of us is unique in our own ways and we need to feel good and be
affirmed to do this-especially young developing kids. ooh, too much goosh!
too small is only in our mind. however, not enough grip is something we
can fix with a different TD.
Ramona M. Okumura, CP
Lecturer, Division Prosthetics Orthotics
Dept. of Rehabilitation Medicine, #356490
School of Medicine
University of Washington
Seattle, WA 98195-6490 USA
<Email Address Redacted>
FAX (206) 598-4761
<URL Redacted>
CAPP TD.
Steven P. Chambers
Subj: RE: UCLA CAPP TD
Date: 3/2/00 5:45:37 PM Eastern Standard Time
From: <Email Address Redacted> (Wilson-Brown, David)
To: <Email Address Redacted>
Hi Steven,
Having worked in the paediatric Limb Deficiency Clinic at The Royal
Children's Hospital,Melbourne,Australia,for some 7 years in the 1990's, the
clinic team including myself seviced the prosthetic and orthotic needs for
almost all limb deficient children in SE Australia.
Our experience was that prior to the commencement of our myoelectric
prosthesis program, most trans radial/trans humeral kids were fitted with a
majority of CAPP td's and a small number of Hosmer 12P and 10P hooks. These
were prescribed as a matter of course but were found after a statistical
survey (presented ISPO World Congress, Melbourne 1995)that kids simply
didn't use thier prostheses actively for any meaningful grasping activities.
This was high-lighted by a 75% usage failure rate of all upper limb
prostheses prior to 1991. Of course, this high figure can't be soley blamed
on the lack of prehension power and cosmesis characteristics of the CAPP td
but these were significant factors.
In the same survey, the introduction of the myo programme reversed the poor
wearing rates of these kids. Approximately 73% of all children wearing
prosthesis actively used there myo's and a small number of the newly
introduced TRS Adept child td's.The cosmesis of the VASI and Bock electric
hands was welcomed by the wearers (and especially thier parents!) but it
really was these td's prehension power and abilities that made these
prostheses useful.
So Steven, to cut a long story short, in our experience, the CAPP td's(even
with the heaviest prehension springs) had poor prehension strength and
holding abilities (due to a very small 'thumb' surface area), was unpopular
cosmetically by both patients and parents and was therefor in a majority of
cases rejected.
I personally recommend the fitting of a 'crawling' mitt when the baby can
essentially sit unassisted, be fitted with an appropriate body powered hook
device when beginning to walk and perhaps be fitted with a larger hook, TRS
V/Closing td or preferably an electric prosthesis around 2-21/2 years of
age. I cannot emphasis the importance of proper initial and followup
prosthetic training and preiodic review by an experinced prosthetist and/or
a suitably trained therapist. This is the key.
If you want more information regarding paediatric prosthetic management,
there are a number of good books and articles published on the matter. You
might like to talk to Winifred Heim (Prosthetist)and Sheila Hubbard (Occ
Therapist)at The Bloorview McMillan Centre in Toronto. Very knowledgeable
people.
I hope this imformation helps you.
David Wilson-Brown.
(Prosthetist Orthotist)
Caulfield General Medical Centre,
Melbourne, Victoria, Australia.
Subj: Re: UCLA CAPP TD
Date: 3/2/00 3:29:38 PM Eastern Standard Time
From: <Email Address Redacted> (R. Okumura)
To: <Email Address Redacted>
On Thu, 2 Mar 2000 <Email Address Redacted> wrote:
> Our practice is basically geared toward adults, and we see very few
children,
yes, children are seen in a concentration in the children's hospitals and
then very sporadically through the general private practices. it is quite
unusual that you see so many UEP's in adults as they also generally
gravitate to one of the practices in an area and the other practices see
very few
> and even less upper limb amputee children.
even though this is probably the most common limb deficiency, the
handicap is the minimum as cosmesis is probably the greatest handicap
for the unilateral presentations. most do not wear prostheses in
adulthood.
>The child that I am most concerned
> about at the present time is 9. This child is quite happy with the CAPP and
> so are his parents.
i think this is the same phenomenon as the post-polio clients who want
metal KAFOs and do not switch to plastic. lots of it is i think the body
image they have formed. they do change if they get a different
prescription, at 9 they are still adaptable and can without so much
frustration learn the subtleties of a different shape for function.
>As you pointed out, the Kraton pads do wear out often.
> Also he quite often loses the thumb pad. I guess you have experienced all
of
> this.
yes, the thumb is locked in only by the two dots and it is easier to
fiddle with and pull off. it can only get lost if it gets pulled off. it
does not fall off during activites. as i mentioned, it is in the design
for the pads to wear as this increases the coefficient of friction. most
families don't report this as a problem. the thumbs wear out the most
because the kids us the end of the thumb to push buttons and the surface
area is small for the repetitive force. i replace more thumbs that palms.
> What is the upper age limit that a child is fitted with the CAPP? Are there
> any steadfast rules about this?
joann who replied to the list is a CAPP OT and speaks with the most
authority on what the age range is.
as far as steadfast rules, i don't practice with many of them as far as
TDs are concerned. in fact, i am the UEP instructor for out P & O
curriculum and i teach fitting to meet the needs of the client.
if your client can do all of the activities he chooses with this TD and he
does not mind the differential in size, who are we to tell him that this
is wrong? or doesn't look right? in reality anything other than being born
with that hand normally formed doesn't look right.
however, he is 9 and his needs will change. you might suggest to him,
them that he discuss with you what he does, how he uses it. are there some
activities that he does not do because he is not able to get assist
from his TD. and keep this an open ended discussion, that might include
not wearing one! there is often a lot of silence to the questions, but ask
based on what your kids do/did at 9 y.o. ask specifically: does he not
build models, climb the jungle gym, jump rope, play baseball, etc. using
your knowledge of bimanual activities and the grasping surfaces and pinch
forces required--ask the parents if they observe hesitation to play such
games. some kids are couch potatoes by nature and that's okay, but if it
is a choice because the prosthesis is not a good tool, then you can
suggest changes to try for one prosthesis, and you can always put the
capp back on anyway!
the good news is when you make a new prosthesis with the CAPP, and he
grows and he changes to a different TD, the size will lenthen the
prosthesis overall and it will not be so short.
>In your experience, what is the oldest
> patient you have seen who uses the CAPP?
my patients have shifted to something else around 6 or 7. after this age,
the activities they do in school do not require learning bimanual fine
motor skills, so they can function with other TDs quite easily. lots go
to hands, some go to ADEPTs and dorrance hooks with plastisol. look up
sheila hubbard's journal publications on functional requirements by age.
sorry i don't have the references. she is form toronto.
>Since the CAPP is smaller than most
> TD's I don't think that it would be useful for a teen or an adult. Maybe
you
> can enlighten me on this.
these kids do not NEED a prosthesis for ADL if they are unilateral. most
do perfectly well without one and most do not wear one and are great
members of society, if you don't believe me go to the I CAN website.
many believe that wearing any kind of a prosthesis is a hinderance. :)
have you ever tried to wear one for a day or two? it distracts you
from your task because you have to do so much planning to get it to work
well.
my biggest reason for fitting children is that they easily learn how they
work and it is like riding a bike. they may stop wearing one, but if they
find a need to use one as an adult, they put one on and can use it.
trying to learn as an adult though is an arduous task.
remember that the TD is only another tool. and sometimes you need a small
screwdriver and sometimes a larger one works. for example, i have an adult
client who has an 8 1\2 myo hand prosthesis, a 7 body powered prosthesis
and a socket with a flexion wrist and a 10X right on the end so he can
weld. form follows function, so as i teach my students, you need once in
a while to get out of the box and advocate for what you client wants and
not be one of the normal people trying to make them normal too, because
every one of us is unique in our own ways and we need to feel good and be
affirmed to do this-especially young developing kids. ooh, too much goosh!
too small is only in our mind. however, not enough grip is something we
can fix with a different TD.
Ramona M. Okumura, CP
Lecturer, Division Prosthetics Orthotics
Dept. of Rehabilitation Medicine, #356490
School of Medicine
University of Washington
Seattle, WA 98195-6490 USA
<Email Address Redacted>
FAX (206) 598-4761
<URL Redacted>
Citation
Steven P. Chambers, “MORE RESPONSES UCLA CAPP TD,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/213870.
