Re: UE Terminal device
Jessica Imhof
Description
Collection
Title:
Re: UE Terminal device
Creator:
Jessica Imhof
Date:
11/3/2010
Text:
Thanks to those who responded. I greatly appreciate your time.
We decided to go with a Hosmer 99X. We also looked at the 5XA, but we felt that
the 99X was more suitable as far as length and weight.
Jessica Imhof, Prosthetic Resident
Tidewater Prosthetic Center, Inc.
150 Burnetts Way Suite 300
Suffolk, VA 23434
(757) 925-4844
____________________________________________________________________________________________________________________________
I would suggest a Hosmer hook because A. it is voluntary opening and
small enough to be able to see the object that is to be worked with or
B. a voluntary opening hand. I am suggesting voluntary opening because
your patient may find it difficult to maintain the pressure needed to
effectively operate a voluntary closing terminal device. Just my 2
cents.
Ps. You may find yourself dealing with cosmetic issues as well. Good
luck.
______________________________________________________________________________________________________________________________
I am an MD and below elbow amputee and wearing a range of terminal
devices with lots of strain. I work as forensic pathologist, I work
death scenes and as that we examine, transport, .. bodies and given
two hands one gets about half the weight. My orthopedic technician
knows that and so we spent about two years trouble shooting, now we
got most parts together for unserviced reliable prosthetic function.
As I also have some manual hobbies, garden work and so on, I have
cared about terminal devices.
1) I found that wrists and cable mounts were very problematic under
higher strains and we built our own unit that is now present in a
final version after a number of prototypes that we systematically
improved ( <URL Redacted>. Also I designed a new way for
Bowden cable mount that survives a lot longer, generates complex
friction force distribution and that allows precise cable control
under minimal and maximal forces. I patented it mainly because I did
not want anyone else to file for a patent and then sell it back to me,
so licenses are free or cheap, I just wanted to protect that from Otto
Bock or people like that, that means I will allow others to build it -
but you just cannot patent it yourself if you understand what I mean.
I came up with the design, sewed / constructed 2 prototypes, convinced
my orthopedic technican and then these guys went to work and perfected
both setup, material choice and parts. It is not perfect but we are
getting there. I am positive my technician can explain how it is all
done. (As opposed to the discussion about the eBay socket kit my
experience is that self made parts are FAR more reliable and better
than commercial parts - but that is because we are a bunch of
professionals with tooling / moulding / engineering / robotics /
technical medical background.) - - - Let me know if you are interested
in more details.
2) The choice of terminal device is governed by what the boy wants to do.
Currently the best device overall is the Hosmer steel work hook
model 7 but it is rather heavy and only adult size. It is most
versatile, useful and both strong and precise in its grip. If I was to
take one part to go anywhere for function I would probably take that.
It is very useful for sewing, working with tools, kitchen work,
shopping, lugging stuff, carrying boxes but it is NOT so good for
handling objects that must not be scratched or thin plastic bags, car
steering wheels et cetera. Unless you want to manufacture some
silicone finger covers for that hook :) (not a joke: my orthopedic
technician offered to make some for me).
For very strong grip and relatively low cable tension, the V2P
Prehensor (Bradley Veatch, ADA Technologies) is cool. It allows for
variable tension setting. I modified the claws with a super grip pad
and that increases grip power by a whole dimension. However that grip
pad would require rather frequent swapping / replacement such as once
every 2-4 weeks depending on usage. Consumable grip pads are super
though - you go through them like others go through working / package
handling type gloves.
If it has to look like a hand, a Becker hand might be useful. The
Becker Lock Grip starts at size 6 1/2. However I have not found a
really well padded good looking well fitting silicone glove so I am
wearing actual packet handling / work gloves with it. That is a really
good combination though as the Becker hand fits nicely into stock work
gloves of all kind of makes - some a bit better, some less optimal,
but mostly no problem.
For everyday work, lots of computer work and not too much fancy tools
/ cutlery I also like the Hosmer 555 aluminum hook. It is extremely
light which reduces strain a lot, and I still can load it with enough
rubbers to hold full coffee pots and full shopping baskets.
I do not recommend any Otto Bock hooks. I have gone through a number
of them and they all failed rather early on. I do not recommend Otto
Bock wrists, they started to wiggle rather early as well, one locked
up within minutes of usage, another began to fail after about 3 months
or so. The Otto Bock voluntary opening hand that I have is cool for
only one reason - it fits into a Regal cosmetic glove. The hand itself
is not very strong, and it has an irritating type of resistance now
that points to an ill fashioned mechanism. Their two-way-pull hand
failed after minutes of usage as well and that is why that went back
to the factory and was never seen again. So for body powered arms I
would not recommend that brand.
____________________________________________________________________________________________________________________________
Contact TRS and evaluate their voluntary closing terminal devices, they have
quite a few advanced types! Do a good job!
____________________________________________________________________________________________________________________________
Jessica - the terminal device you use will be determined by the tasks your
client wants to do. The TRS voluntary close device is nice (adept probably as
it is a bit smaller than the Grip 2) especially as he hasn't used anything
before and doesn't need to unlearn VO type hooks. Harnessing is a bit different
if you use a VC for a client using elbow jts.
The clients I have seen using elbow joints don't often use the fairlead cable to
position the elbow jt and I have come to using more of a triple control harness
- one cable controls the TD, one elbow flexion and one the lock mechanism.
BTW, I had very good success with a client with ED type amputation rolling on a
custom liner that has buildups to fill in the condyle areas then a suspension
sleeve from the socket to the sleeve with a one way valve (I like the OttoBock
V5) and he draws the air out of the socket with his mouth. Kind of like an
elevated vacuum socket for a TT level, without the pump! You could call me if
you want more info about this fitting 289 259 4980
____________________________________________________________________________________________________________________________
Have you talked with Jeremy Brooks in the las vegas area. You can find him at
the registry at ABC.
______________________________________________________________________________________________________________________________
We decided to go with a Hosmer 99X. We also looked at the 5XA, but we felt that
the 99X was more suitable as far as length and weight.
Jessica Imhof, Prosthetic Resident
Tidewater Prosthetic Center, Inc.
150 Burnetts Way Suite 300
Suffolk, VA 23434
(757) 925-4844
____________________________________________________________________________________________________________________________
I would suggest a Hosmer hook because A. it is voluntary opening and
small enough to be able to see the object that is to be worked with or
B. a voluntary opening hand. I am suggesting voluntary opening because
your patient may find it difficult to maintain the pressure needed to
effectively operate a voluntary closing terminal device. Just my 2
cents.
Ps. You may find yourself dealing with cosmetic issues as well. Good
luck.
______________________________________________________________________________________________________________________________
I am an MD and below elbow amputee and wearing a range of terminal
devices with lots of strain. I work as forensic pathologist, I work
death scenes and as that we examine, transport, .. bodies and given
two hands one gets about half the weight. My orthopedic technician
knows that and so we spent about two years trouble shooting, now we
got most parts together for unserviced reliable prosthetic function.
As I also have some manual hobbies, garden work and so on, I have
cared about terminal devices.
1) I found that wrists and cable mounts were very problematic under
higher strains and we built our own unit that is now present in a
final version after a number of prototypes that we systematically
improved ( <URL Redacted>. Also I designed a new way for
Bowden cable mount that survives a lot longer, generates complex
friction force distribution and that allows precise cable control
under minimal and maximal forces. I patented it mainly because I did
not want anyone else to file for a patent and then sell it back to me,
so licenses are free or cheap, I just wanted to protect that from Otto
Bock or people like that, that means I will allow others to build it -
but you just cannot patent it yourself if you understand what I mean.
I came up with the design, sewed / constructed 2 prototypes, convinced
my orthopedic technican and then these guys went to work and perfected
both setup, material choice and parts. It is not perfect but we are
getting there. I am positive my technician can explain how it is all
done. (As opposed to the discussion about the eBay socket kit my
experience is that self made parts are FAR more reliable and better
than commercial parts - but that is because we are a bunch of
professionals with tooling / moulding / engineering / robotics /
technical medical background.) - - - Let me know if you are interested
in more details.
2) The choice of terminal device is governed by what the boy wants to do.
Currently the best device overall is the Hosmer steel work hook
model 7 but it is rather heavy and only adult size. It is most
versatile, useful and both strong and precise in its grip. If I was to
take one part to go anywhere for function I would probably take that.
It is very useful for sewing, working with tools, kitchen work,
shopping, lugging stuff, carrying boxes but it is NOT so good for
handling objects that must not be scratched or thin plastic bags, car
steering wheels et cetera. Unless you want to manufacture some
silicone finger covers for that hook :) (not a joke: my orthopedic
technician offered to make some for me).
For very strong grip and relatively low cable tension, the V2P
Prehensor (Bradley Veatch, ADA Technologies) is cool. It allows for
variable tension setting. I modified the claws with a super grip pad
and that increases grip power by a whole dimension. However that grip
pad would require rather frequent swapping / replacement such as once
every 2-4 weeks depending on usage. Consumable grip pads are super
though - you go through them like others go through working / package
handling type gloves.
If it has to look like a hand, a Becker hand might be useful. The
Becker Lock Grip starts at size 6 1/2. However I have not found a
really well padded good looking well fitting silicone glove so I am
wearing actual packet handling / work gloves with it. That is a really
good combination though as the Becker hand fits nicely into stock work
gloves of all kind of makes - some a bit better, some less optimal,
but mostly no problem.
For everyday work, lots of computer work and not too much fancy tools
/ cutlery I also like the Hosmer 555 aluminum hook. It is extremely
light which reduces strain a lot, and I still can load it with enough
rubbers to hold full coffee pots and full shopping baskets.
I do not recommend any Otto Bock hooks. I have gone through a number
of them and they all failed rather early on. I do not recommend Otto
Bock wrists, they started to wiggle rather early as well, one locked
up within minutes of usage, another began to fail after about 3 months
or so. The Otto Bock voluntary opening hand that I have is cool for
only one reason - it fits into a Regal cosmetic glove. The hand itself
is not very strong, and it has an irritating type of resistance now
that points to an ill fashioned mechanism. Their two-way-pull hand
failed after minutes of usage as well and that is why that went back
to the factory and was never seen again. So for body powered arms I
would not recommend that brand.
____________________________________________________________________________________________________________________________
Contact TRS and evaluate their voluntary closing terminal devices, they have
quite a few advanced types! Do a good job!
____________________________________________________________________________________________________________________________
Jessica - the terminal device you use will be determined by the tasks your
client wants to do. The TRS voluntary close device is nice (adept probably as
it is a bit smaller than the Grip 2) especially as he hasn't used anything
before and doesn't need to unlearn VO type hooks. Harnessing is a bit different
if you use a VC for a client using elbow jts.
The clients I have seen using elbow joints don't often use the fairlead cable to
position the elbow jt and I have come to using more of a triple control harness
- one cable controls the TD, one elbow flexion and one the lock mechanism.
BTW, I had very good success with a client with ED type amputation rolling on a
custom liner that has buildups to fill in the condyle areas then a suspension
sleeve from the socket to the sleeve with a one way valve (I like the OttoBock
V5) and he draws the air out of the socket with his mouth. Kind of like an
elevated vacuum socket for a TT level, without the pump! You could call me if
you want more info about this fitting 289 259 4980
____________________________________________________________________________________________________________________________
Have you talked with Jeremy Brooks in the las vegas area. You can find him at
the registry at ABC.
______________________________________________________________________________________________________________________________
Citation
Jessica Imhof, “Re: UE Terminal device,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 22, 2024, https://library.drfop.org/items/show/232056.
