Single-Handed Solutions

Recently Published Article on the Shriners Blog!

2011-10-19T20:38:00.001-04:00

Debra A. Latour, M Ed, OTR/L, has worked at Shriners Hospitals for Children in Springfield, Mass for 13 years. Before she was employed by the hospital, she was a patient. Her parents sought treatment at Shriners when she was a toddler for an upper limb deficiency.
For many years, Debi used the traditional body-powered prosthesis which is activated by a figure-of-eight or a figure-of-nine harness system, using the opposite shoulder as the power source. Many users of this system complain of discomfort from the harness, typically the rubbing on the skin by the harness, asymmetry of the shoulders, pain in the opposite shoulder area, difficulty while performing tasks with both limbs, and diminished physical appearance. When Debi began to experience her own problems with the usual harness system, she relied on her 30 years of experience to solve her issues.
As a Senior Occupational Therapist, Debi knows exactly how to help patients develop skills needed to live as independently as possible and to help improve the quality of their lives. In an effort to achieve these goals for patients with an upper limb deficiency, she invented a new and improved way of harnessing a body-powered prosthesis called the Ipsilateral Scapular Cutaneous Anchor system (the “Anchor”). Her design eliminates the usual harnessing, often a source of complaint and one reason why children reject prostheses.
Debi submitted a paper on the “Anchor” to the American Academy of Orthotists & Prosthetists which was accepted for presentation at the 2011 Annual Meeting & Scientific Symposium in Orlando, FL. Presentations such as this serve to inform professionals in the community of new and creative solutions in treatment and also promote Shriners Hospitals for Children as a center of innovation and excellence in treatment, research and education.
While attending the symposium, Debi was interviewed by a reporter for O&P Business News. She provides a wonderful account of how her invention and her blog, Single-Handed Solutions, materialized. Watch for the link soon.

How Have You Been...?

2011-02-04T22:26:00.000-05:00

Hello Everyone! I hope that you have enjoyed festive holidays and are entertaining a blessed new year.... Now, as much as we here in the northeast might love our four seasons (yes, winter being one of them), I for one am seriously looking forward to a pleasant spring!
I apologize for the long hiatus and though I was not publishing entries, I do have 10 "in the works" and almost ready for your review. Before I tell you what we will be discussing, I would like to take a moment to share some of my adventures. I had the privilege of travelling to Belgium to speak at the Loth Symposium at the invitation of Dr.Corrie von Sluis and Mr. Gerritt Visser from The Netherlands. I re-acquainted with several occupational therapists, prosthetists and engineers and learned much from them. It was a fantastic opportunity and I enjoyed a wonderful time. Thank you to you all!
Upon my return I underwent surgery with a lengthy recuperation. During this time I responded personally to many of your inquiries and drafted the entries that you will be reading. We will pick up where we left off: with activities of daily living. These upcoming issues will demonstrate strategies for completing various fasteners on clothing and jewelry, as well as diversional activities... cutting, computer key boarding, playing the guitar and knitting.
Thank you for reading and being a part of this blog. Single-Handed Solutions is now read in 51 countries and is translated into 34 languages. As in the past I look forward to your comments, suggestions and inquiries. May you be richly blessed!

How Do You Do...Fastening a Watch?

2010-10-21T21:44:00.000-04:00

Watches can be found in several different types of styles, with very different watchbands. Of course, I love a nice-looking watch! But there are two very distinct features that I seek in a watch. First, I need to be able to see the numbers on the face. I typically look for a watch with a large face or with easy to read numbers. Since I am a health care professional, I also like a second hand. The second feature I analyze is the clasp fastening. It has to be a type that I can do by myself and without taking alot of time. My favorite "work" watch is made by Invicta with a two-tone stainless steel hinged bracelet clasp. Unfortunately I recently broke one of the links. These are my other two favorites. One is a typical buckle style fastener (the brown one) and the other (the gold watch) has a double-fold clasp. I can fasten both of these watches pretty easily using the prosthesis (either the hook or the Adept terminal device) or with my residual limb. Let's look at how I do this task. Please remember that these are descriptions of how I accomplish tasks. There are many methods and strategies to accomplishing tasks. It is my hope that this blog will serve as a springboard of thought and empowerment to others to find successful techniques that will work for you, your clients or your loved ones who might be experiencing challenges. So let's check this out...
Without a prosthesis:
First the traditional buckle style watchband:
Positioning is important for my success. I wear my watch on my left wrist and will typically support my left forearm on my left thigh to stabilize the area so that I can best maneuver my residual limb. I 'grasp' the watch with the crook of my right elbow and position the watch on my wrist.

Then I manipulate the band so that I will be able to feed the end into the buckle.

Once it is through the buckle, I pull it the remainder of the way using the terminal end of my residual limb and my left thigh.

I use my residual limb to push the strap though the placement holders once through the buckle

so the watch is completely fastened.

And now the double hinge metallic strap:
Again, positioning is a key to sucess. I drape the watch over my wrist using my residual limb. My left forearm is supported on my thigh to stabilize my arm during the task.

I align the strap onto the prongs of the clasp

and use my residual limb to push the clasp and hook it together

Then I push the second hinge over the first in the same fashion

And it's on!

With a prosthesis:
The traditional buckle watchstrap:
I drape the watch on my wrist, pinch the strap, push and then pinch and pull it to get it through the buckle.

And it's on!
And finally the double hinge watchstrap:
I grasp the watch with the terminal device and position it on my wrist.

I line up the hooks on the clasp and then pinch

Then I fold over the second hinge and repeat the process

And the watch is on.

I must confess that photographs give the appearance of simplicity. I have spent many hours practicing these techniques, beginning when I was very young. Don't be discouraged... any skill worth acquiring is worth working toward with diligence! And being maximally functionally independent is a worthy goal.

Next to be published will be buttoning the cuff button ... Check back next week!!

In the meantime, be well, be blessed.

How Do You Do.... Gloves?

2010-10-12T22:28:00.000-04:00

Let's talk about something new.... We cleaned closets this week-end in anticipation of the cold weather approaching quickly! Temperatures here in New England are expected to plummet with the high only reaching about 50 degrees. I'll need to don a hat and gloves for our nightly walk. I don't know about you, but it can be costly buying gloves. Good gloves typically are priced beginning at $20; more for fitted or lined leather; less for the cheapies. In any case, I don't like paying $20 for the use of only one glove!! Especially since I'm likely to lose the left (the one I need and use) and am stuck with the right! (Anyone need a right hand glove? I do have a few!) There have been times when friends or family will pass on to me the left hand glove when they have misplaced the right in the pair. -One glove is not usually helpful for a two-handed person, but can be a blessing to me!

Over the years I've discovered a few helpful hints to keep my hand warm during chilly weather.... my favorite of course is to hold hands with my husband. But there are times when one needs a glove or a mitten. The least expensive option is the 'magic glove'. These are sold in a universal pair, meaning that it's a set of two and that both gloves fit either hand. They are available in a wide assortment of colors and sizes for both adults and children. The benfits are that they are cheap and useable for either hand. The drawback.... they are cheap and not overly warm. One might have to wear a few layers of magic gloves to have a warm hand.

Another solution is the knitted woolen glove or a fleece glove. These are sold in fitted pairs and are warmer than the magic gloves. Since they are fitted and are hand-specific, the problem is that a one-handed person cannot use the other glove.... unless you turn it inside out.

Granted, it's not pretty, but when it comes right down to it function wins over form for staying warm. I'd rather look like a goof and be toasty warm than freezing and frost-bitten.

When I'm out on my snow shoes I like to wear my heavy fleece mittens, often with a pair of insulated glove liners. (True, I don't really wear the pair; I only use the liner on my hand; my prosthesis does not need the extra insulation!) In any case, the mitten fits nicely over my Adept terminal device, don''t you think???

Lastly, and probably most special of all is the pair of fingerless gloves that my friend Hermine knitted especially for me. They keep the palm warm and look chic. Of course, I have the pair to add symmetry!

How Do You Do... Play Guitar?

2010-10-10T20:50:00.002-04:00

My parents let me have guitar lessons beginning in the fourth grade. -I wanted to learn to play so badly! It was about 1965; the Beatles had already won popularity in the U.S. and with it, the guitar became popular as well. As much as I wanted to play, I have to admit that I did NOT love to practice! But that isn't the point of this entry; HOW I PLAYED is the message.
Remember, I have my left hand and use a prosthesis on the right. My left hand manipulated the frets and supported the neck of the instrument. My hook held the pick and strummed the strings. I encountered a few problems however. My cable to activate the hook dug into my upper arm when I positioned my arm around the guitar. Initially I was wearing a prosthesis with a figure of 8 harness. My prosthetist through Shriners Hospitals for Children modified it to a figure of 9 with a Muenster socket and this arrangement solved that problem. My second problem was that the pick would slide out of the tines of my hook. My parents, being very savvy and out-of-the-box-thinkers, glued dense foam on the pick so that I could grab the material instead of sliding off the smooth surface. And my dad came across a rubber tubing which we cut in half-inch lengths and placed on the hook tines so that my hook would remain closed on the pick. (The excursion of my prosthesis around the folk guitar would cause the hook to open) Now, if I'd had a Lite Touch or my current Adept voluntary closing terminal device, I could have worked to maintain the pinch or kept the pick in place with the Sure-lock system. But those had not yet been invented! My third problem? I am not very musical!!

How Do You Do... Washing Dishes?

2010-09-17T14:06:00.000-04:00

Now that we've done all of this cooking, we have a ton of dishes to wash! Believe it or not, washing dishes is a task I actually enjoy. It's my therapy!!!! When I was younger, my sister and I had the responsibility of clearing the table and washing, drying and putting away the dishes nightly. I didn't seem to love it then; probably because there were so many dishes and because there was no choice involved. I recall telling my parents on one occasion that I could not wash the dishes and shouldn't be required to do so because the water would rust my hook. My father was quick to explain to me the scientific properties of aluminum (it doesn't rust) and sent me back to the kitchen. At the time, it was worth a try!
When washing dishes, I hold the sponge in my terminal device.

With the Adept, I use the Sure-Lock and it maintains the grasp for me.

If no prosthesis, I use either a dishcloth draped over my residual arm or I push the sponge with my residual arm and hold the dish in my hand. Glasses are easy... my shorter arm fits right inside the glass to wash it out.

When washing pans, I hold the scrubber in my hand instead and stabilize the pan or pot with my prosthesis or residual arm.

Drying dishes is accomplished by holding the towel in my terminal device or draped on my arm if no prosthesis.

That was easy... we made short work of the dishes!

How Do You Do... Cooking 201?

2010-09-13T22:48:00.001-04:00

My husband loves to eat and I love to cook for him. Since I was chopping, mixing ingredients and indulging in a stovetop creation, we thought it was a great time to seize the moment and add to the blog. So, thanks to my husband Mike and his camera, we have the next edition to How Do You Do... Cooking! I also want to take a moment to speak about learning to cook. Like everyone else from my generation, I took the obligatory Home Ec in 7th and 8th grades. Unfortunately, Mrs. P's rigid lessons did not unleash any culinary desires -or talents- in my heart. That being said, I had a wonderful Chemistry teacher in the 10th grade (Mr. B!) who ignited my interest in creating and encouraged my tendency to use my prosthesis in inventive ways.
-The hook does a wonderful job holding test tubes over a bunson burner. Tonight I am making a pasta primavera with shrimp. I admit it; I'm cleaning out the refrigerator but it really did turn out good!
Before we get started, let's take a peak at some of my favorite cooking tools (though we may not use all of them in today's edition):
my non-skid mat (purchased at HomeGoods)

white anti-microbial cutting boards (Ikea)
one-handed pizza roller (Pampered Chef; used to cut more than pizza)

one-handed pie crust roller (ditto)

double-blade scissors/spoon (a gift!)

Kitchen Aid grater with lid (HomeGoods)

egg yolk separator (Pampered Chef)

bamboo tongs (Pampered Chef)

food pick (Pampered Chef)

And the cooking begins!
I place the non-skid mat on the counter with my cutting board on top of it. This keeps the cutting board from sliding around while I'm trying to chop. Then I use my forearm to stabilize the onion to cut off the ends...
With the prosthesis:

or without:

Then I peel the onion:

and then chop it:

Without a prosthesis, this is how I do it...

I am using my residual limb to push down on the blade. -It does look a little dangerous, but I am very cautious (and at this point in my life) pretty quick.
Add it to the saute pan -with olive oil, of course (and garlic, spices...)

I love the handle on my cutting boards. It's just big enough to slide my residual arm in place to grab the board. Now it's time to chop the tomato. Tomatoes are typically softer and can be squishy. -It's definitely an advantage to use my Adept over the hook with this task!

and certainly more difficult (but possible!) without...

It's even easier with the food pick:

Chop, chop, chop!!!!

Another way to chop is the double-blade scissors device:

And add it to the saute pan:

Now to make the pasta. First, fill the pot with water. It's much easier to keep the pot on the counter if possible, rather than filling it in the sink and lifting it up onto the counter. I place it on a cutting board so I can slide the full pot over to the sink and then onto the stove.

Same steps without a prosthesis: slide the full pot on the counter and place the pot on the stove.

The pasta is done... To move the hot pot to the sink I keep the cover on and gently move it onto the cuttingboard and slide it over to the sink.

Without a prosthesis, I wear an oven mitt on my residual limb:

My colander has expandable handles that stretch over the sink and I dump the hot pasta and water into it...

Dinner is almost ready, but I need to open a jar of seasoning to add to my concoction

and then peel the shrimp...

I use the tongs for serving and hold my plate in my prosthesis -or place it alongside the serving dish...

Bon appetit!
We'll have alot of dishes to wash in the next edition...

How Do You Do... Cooking 101

2010-09-02T20:26:00.008-04:00

Since we were just talking about cutting food, this is a good opportunity to segue into cooking. Now, cooking has not always been a passion... just ask my mother (please, don't ask my brothers, my kids or my husband! -My sister will vouch for me though!). When my daughters were small, someone asked them what was their favorite meal for me to make them... they responded by naming the local grocery store's salad bar. Ouch!
I can thank my friend Elaine for inspiring me to cook more (please check out her blog, http://cookinwithlove.blogspot.com/ for some savory ideas!). I also have to say that cooking is much more enjoyable with my new terminal device, the Adept. I know, this sounds like an ad for TRS(www.oandp.com/products/trs) but honestly, don't you want to know WHY???? It's because of the thumb! Really. It's amazing. Did you know, that in the human hand, the thumb accounts for approximately 70% of hand function? Using the hook, I was notorious for squishing tomatoes, fruit, and bread OR for shooting slippery foods across the room. With the Adept, I can grasp deftly and not pulverize food while cutting. I love it. You should see me chop. I put Mr. Ginsu to shame.
What about mixing? Of course I love my KitchenAid mixer ( who doesn't?) but if mixing by hand I prefer a bowl with a handle. I can grab it with my terminal device to stabilize the bowl. I love bowls that have a non-skid surface on the bottom and a handle that is open. If I'm not wearing my prosthesis, I can hold the bowl by positioning my residual arm at about the elbow length in the handle to stabilize it.
Getting things out of the oven is easy... I use both my hand and my prosthesis to balance the pans - I only need one potholder if using the hook; I use a silicon hot pad (ok, sometimes) when using the Adept.
If I'm not wearing a prosthesis, I definitely cover my residual limb with a potholder or several layers of dishtowels and remove the pan with my hand and arm.
My friends Hermine and Brian love to invite us for their famous Lobster Fest... I am the Official Remover of the Lobster from the Pot. You guessed it, I reach into the pot with my bare hook (NOT my beautiful black Adept) and grab the lobster! And of course, I come equipped with my own lobster dissembly tools!
So, what do YOU think about all of this information? Watch for the next issue... We'll review actual chopping techniques, opening cans (using an electric can opener is just too easy!) and transferring pots of hot water from stove to sink. Enjoy the long holiday week-end and stay safe from Hurricane Earl!

How Do You Do... Cutting Food?

2010-08-30T21:02:00.002-04:00

I'm hungry; aren't you? Eating is something that we do at least a few times a day! Since I have a hand, I use it to hold my fork while dining. I do not use special equipment for this task, but that does not mean it wouldn't be helpful for others. For example, if I lost use of my left hand, I would use my prosthesis to hold the fork or spoon -But a better utensil might be one with a bent angle; especially since my wrist component does not have a flexion action. A great way to grasp utensils with the hook is by pinching it between the 'fingers' and resting the handle on the outer side of the medial or 'thumb-side' finger.

And I would probably use a rocker knife or a rolling pizza knife to facilitate better cutting with the prosthesis.

But this is really about cutting the food. I hold the fork in a similar fashion when I'm cutting my meat. The difference is that I face the fork downward and use it to spear the food.

I then use a knife in my hand.

Once the food is cut, I switch utensils and hold the fork in my hand to eat.

I use a similar technique with my Adept,

only after grasping the fork with the terminal device, I click the button on the Sure-Lock system and it does the work of active pinching for me.

My energy is saved for cutting... and then of course eating!

If I am not using a prosthesis (I admit, that's rare! -I wear my prosthesis typically 15-18 hours per day.), I grasp the fork in the crook of my elbow (residual limb side, of course)

and cut holding the knife in my hand.

Then I transfer the utensil to my hand.

How Do You Do...?

2010-08-26T20:30:00.002-04:00

I haven't forgotten about you! In fact I've been diligently working on the next 12 postings! We'll be talking about cutting food next... but not today. The text is near completion but the photos are stuck in my camera. Be patient with me; I hope to have it all posted soon. In the meantime, I've added a few suggestions for useful tools and will be adding suppliers. Although I may not personally use some of these, I have found them to be helpful for others at times. Watch for the subtle changes to this blog and stay tuned for more strategies, information and insight.

How Do You Do... Shoe-tying?

2010-08-19T22:46:00.001-04:00

Let's talk about tying shoes. It's been one of the most frequently-asked questions (#1 is how do you put on panty-hose, but we don't quite know each other well enough to discuss that yet!)

Shoe-tying has been made easier of course with the advent of velcro and elastic laces.

That being said, I like to tie my own shoes, especially if they match the rest of my ensemble!
Since I am typically wearing my prosthesis, let's examine the steps involved:

1. I cross laces at the onset of the task--it saves a step:

2. I use my hand to push the (left hand) lace under the crossed laces:

3. Then I form a loop with my left hand:

4. And I wind the lace held by my TD around it, and push it through the 'hole' created by the lace with my left hand :

5. I then grasp both laces with each hand (yes, I often refer to my prosthesis as my hand; it is truly an extension of my 'self') and pull laterally:

6. Voila!

Tout fini! (All finished!)

That wasn't so hard, was it?

I'd love to show you how I tie shoes without my prosthesis... I use basically the same staps, only I use the crook of my elbow to 'grasp' the lace. Positioning is key (remember that; I tend to say that alot...)!

1. Cross the laces;

2. Use the hand to push the lace under the crossed laces;

3. Form the loop with the hand;

4. Wind the lace with the crook of the elbow and push it through the 'hole' created by the lace with the hand;

5. Then grasp both laces with each side--hand and elbow crook-- and pull laterally:

6. Voila!

Fait accompli! (Task accomplished!)

Again.... easy! -Though the old adage, "practice makes perfect" certainly carries alot of weight! I remember being 5 and 6 years old and practicing ad nauseum tying shoes with and without my prosthesis. I remember being so angry and crying in frustration because I just couldn't get it together. But, I also remember the sweetness of victory; of practicing, correcting error, perfecting technique until I got it. The sweetness of victory; of overcoming and being able to achieve.... beautiful. I re-live it now; I re-live it in the successes of those empowered.

Hooray! What shall we practice next??? Let me know; otherwise it's my pick!

How Do You Do.... Series Introduction

2010-08-16T21:49:00.004-04:00

What an encouragement to receive your responses both publicly via blog and privately!! Thank you so very much. To give you an idea of what to expect in the very near future, and as part of the 'introduction', I was thinking about the phrase we have used so commonly when we meet another: "How do you do?". Frequently, after I meet someone I am asked, "How do you do.... (a specific task/activity)?"
So.... let's chat about that! I will be commenting on how I address specific bimanual tasks both with and without my prosthesis... When applicable, I may provide additional info between the voluntary closing (Adept) and voluntary opening (hook) terminal devices.
I've used the hook for most of my life. Believe it or not, it is by choice, and no, not because I loved being called names (you guessed it, Captain Hook was the most common, least imaginative!) It was because even early on, I recognized that for me, (and that is key) function takes precedence over cosmesis. At the time... and we are talking decades ago, there were not many choices! So as I introduce the How Do You Do series, let's talk about the 'times' and the culture of the times for a moment. We now live in a culturally-diverse and culturally-aware society. Everything in medicine, education, government, economics, entertainment, commerce and religion speaks of it. But that was not always so...
I was born in the mid-1950's. If you were to Google those years you would find that Eisenhower was president, racial segregation was ruled unconstitutional, Rosa Parks refused to give up her seat on public transportation, the first US satellite completed orbit around the earth, Alaska and Hawaii became states and domestic airlines opened their passenger service between NYC and Miami. It was in this time that I was born; and in spite of not having all 10 fingers and all 10 toes; was "wondrously formed" (Psalms 139.14). Why is this important? It is important because:
a. it was the reality for that period of time; b. it would be a full 20 year time period when the period of 'tolerance' would then emerge; c. it paves the way for the period of 'acceptance' that we now experience.
My reality was this:
1. I was born without my right forearm and hand;
   (for the record, as scarey as this probably was for my parents, I do have multiple siblings who were born after me, all with 10 fingers and 10 toes!)
2. my parents taught me that God made me this way;
3. there was a measure of expectancy/accountability:
        -they also taught me that I could do everything that anyone else could do,
        -especially if I wanted to, though I might need to do it differently;
        -they would help me to figure out those diffent ways
        -and that I was not 'lesser' for any of these reasons.
So the impact of these realities was this:
1. I could not change how I was born: "it is what it is";
2. there was a divine purpose and plan for me to be this way;
3. the opportunity of using a prosthesis (at that time, for that culture) was a privilege and the expectancy was that I would learn to tolerate and use it to the best of my ability with their encouragement and support to be the best I could be and on a par with my peers.
During early childhood through adolescence my options were a body powered hook, a body powered cosmetic hand, a passive cosmetic hand, or nothing. 'Nothing' was not really an option. -Not in my family culture! For me, in the 1960's and 1970's the body-powered hook was the best option: lightweight and functional. In my very pragmatic mind, I knew that I did not have 2 hands, was highly unlikely to grow a hand and decided that I did not need to look the part, but wanted to function the part!
Stay tuned for the next installment: How Do You Do......?

Why are you starting a blog now?

2010-08-12T21:02:00.001-04:00

GREAT QUESTION!! Someone once told me that some questions are best answered with a question. That being said; Why NOT? I have over a half century's experience of living with a congenital limb deficiency, the blessing of fantastic parents who taught me that "can't" was not an option; and knowledge that possibilities are only as limited as the mind will allow and creativity, humor and will are the keys to ability.
In an age where we are seeking the benefits of maximal independence and quality of life, how could I not share my own nuggets of empowerment?!
NOW is a great time to begin... so let's, shall we?
I use a body-powered prosthesis and have since I was about 2 1/2 yers of age. I received my first prosthesis (passive) at a little over a year old. I joke that some mothers save their children's shoes; mine saved my arms! And yes, I still have most of them.
Let me tell you about my new prosthesis. It has a black carbon-fibre forearm with a jet black Adept Prehensor voluntary-closing terminal device fabricated by TRS of Colorado. (Check out the website!) Its function is enhanced by the Sure-Lok Cable Lock and Control System also offered by TRS. Access to body power is achieved by my own invention, the Anchor, a harness-less technology currently offered to patients at Shriners Hospitals for Children and hopefully soon available to the public.
This is my favorite prosthesis. I love the savvy look, the ability of the thumb and that I can continue to do everything that I need to do and want to do, easily! You can see how happy I am in the photo above!
This blog is intended to share experiences and to serve as a venue to answer questions... from others who experience upper extremity 'one'ness be it congenital or acquired, or those providing care, guidance or support. Please feel free to post your questions.... I'll use this column to answer inquiries.... and will post at least one a week!! In the meantime: be well, be happy, be at peace!