ADL (activities of daily living) are a roundabout way measure by which rehabilitation outcomes are measured. They contain household activities or housework, everyday activities, work and play, eating and laundry, cleaning and fixing up stuff. And, what is good enough for rehab outcomes sure is good enough for me. So I figured why put up with blurred concepts when we can be far more concise?
[this is comprehensive, it really is - this time there are lots - and I mean *lots* - of images - puhleeze, wait until they are loaded, get a drink, go to the bathroom, whatever, *then* read]
I started to become intrigued by reading that a top notch scientific and ambitious hand project was advertised with "the hand will be able to perform at least the 80% of the grips necessary in activities of daily living (ADLs)". Reading this is truly funny! My heart makes a little jump - it's sheer joy that makes me say that and no rational basis - see, my current prosthesis performs nearly 100% of my ADL required grips and the very few things I really cannot do won't change with another prosthetic hand but their completion requires a teetotally different wrist and hand technology. Yet we all want to sing that song, "perform at least 80%", and already then the sun shines inside my soul!
Of course in real life, the emotional side of hand prosthetics is grossly if not totally underestimated by manufacturers. Assume that I let my own personal experience with the customer service of some huge German prosthetic manufacturer pass slowly in front of my eyes. And assume some other people's customer service experiences match mine. Now just for sake of argument, assume that some of these other folks told me that a major reason for them to buy an iLimb - not made by that German but by a British manufacturer - would be to specifically not buy from that very German prosthetic manufacturer they had these customer service experiences with. Now you may very well think of those as rather emotional reasons and wonder about who, why and what - but I could not possibly comment. Because funnily enough our minds do play tricks - and while our minds do all that (got you thinking now?) it's still the prosthetic hand that provides the grip (if it does, that is). With all that in mind I then wondered what of these were adequate ways to formulate prosthetic ability (focus on the hand now, will you) in relation to the proposed "80%" sentence above:
- I can do ~80% of the grips necessary in ADL with the prosthesis (remark: but I could also solve these problems using other means, like, when not wearing a prosthesis at all).
- I require a prosthesis to do ~80% of the grips necessary in ADL (remark: but I could also solve these problems with another type of prosthesis, so what other types of arms are these).
- I require a particular type of prosthesis to do ~80% of the grips necessary in ADL (remark: and no other prosthesis or means can do this quite as well).
Then I wondered how that relates to real solutions such as wearing no prosthesis, wearing a cosmetic prosthesis, wearing a body powered arm, wearing a myoelectric arm and wearing an electronic bionic arm.
To just let you know - I am not free to choose whatever type of prosthesis I want. With current prosthetic parts, I will not successfully wear a myoelectric arm. A hard socket that embraces my elbow was made, and I tried it - the experience was painful and the socket did not stay fixed on my arm too well. It slid off as my arm is long and sleek and no rounded curves. I cannot wear a liner / pin system as no myoelectric wrist unit accomodates for a pin lock to reach far out into the prosthetic hand, so a myoelectric hand with a wrist would necessarily be too long. Maybe Ossur and Otto Bock should make their parts compatible. So I am stuck with hard sockets there and these extend over the elbow and embrace it to make them stay in place. But my elbow is thin and bony, the little subcutaneous fat in that region is scarred from an operation, contains painful nodules and also, the socket did not allow full extension or full flexion, nor did it withstand a pull of over about 2 kg - after exceeding about 1.5 kg, the embracing parts would start to compress my tender skin and hurt. The pain was severe unless I did not use the prosthesis for anything. It was bearable as long as I kept my elbow slightly flexed and no weight on the prosthetic hand at all. Due to skin issues I need to wear a constant film of cream on my stump and that is of no help when trying to keep the hard socket stay in place. Then after two hours of wearing that arm, my neck and shoulder muscles started to get iron hard from tension. On top of that, the myoelectric parts were not a bit as reliable as the body powered arm that I have. Also I am spoiled by the high degree of differentiating grip power (I do handle raw eggs or sewing thread) and I am spoiled by a good liner/pin lock system and a body powered arm fully tweaked to performance. As we all know the combination of our self constructed wrist unit, the Becker hand, and an Otto Bock MovoHook 2Grip does it for me right now.
So the time has come for a comprehensive inventory of ADL. Obviously such an inventory is life style dependent and so you'll have to put up with a particular lot of my subjectivity. However if you are a good evaluator you'll be able to pull that off in any other given situation as well. If you work for an insurance and require some extra tips for your expertise, give me a call and we'll negotiate a price ;-)
[work in progress / more details following]
[1.0] Personal care, dressing
[1.1] Washing hands, using brush
|Hook||Becker hand||OB hand||cosmetic arm||stump||comparison result|
|use brush||+1||+1||0||-1||+1||Becker hand, hook, stump|
(+2: perfect, +1: works well, 0: life is a mess, -1: don't do it, -2: will fail)
[1.2] Cleaning glasses
[1.3] Trunks, pants, trousers
[1.4] Wrist watch
[1.5] Zipper of a jacket
[1.6] Tie shoe laces
[2.0] Preparing food
[2.2] Can opening
[2.3] Espresso version 1
[2.4] Espresso version 2
[2.5] Cucumber salad
[2.6] Food tray in public restaurant / cafeteria
[2.7] Using fork to cut meat
[2.10] Soft drink can
[2.11] Hold salad plate
[2.12] Refrigerator door
[2.13] Hold glass
[2.14] Hold bottle with juice
[2.15] Hold milk carton
[2.17] Frying meat
[2.18] Handling a plate
[2.19] Frying eggs
[2.20] Toast bread
[2.21] Water glass
[3.0] Moving about, vehicle maintenance
[3.1] Driving - steering wheel
[3.2] Driving - grabbing parking card
[3.3] Car wash
[3.5] City walking - handling drinks
[4.0] Shopping, purchasing
[4.1] Wallet and phone
[5.0] Clothes, laundry, cleaning up, washing stuff
[5.2] Cleaning frying pan
[5.3] Garbage bag
[5.4] Take coat
[5.5] Handle cardboard box
[5.6] Jacket and coathanger
[5.8] Laundry - fold socks
[5.9] Laundry - ironing
[5.10] Laundry - get washed items out of washing machine
[5.11] Pick up stuff
[5.12] Pull sleeve of garment off arm
[5.13] Put on tie
[5.14] Vacuum cleaner
[6.0] Electrics, entertainment, gadgets
[6.1] Handling a book
[6.2] Handling a camera
Accessing the battery and memory card is easy as the adaptive grip gently but securely holds the camera at any given angle.
[6.3] Handling a mobile phone
[6.4] Handling a card reader
[6.5] Installing PC parts - cable plug manipulation
[6.6] Operate light switch
[7.0] Manipulations, manual work
[7.1] Sewing, cutting
[7.2] Manipulating thread
Otto Bock MovoHook 2Grip:
Becker Lock Grip hand:
[7.3] Mount new lamp
[8.1] Handle paper
[9.0] General factors; random actions of raw performance
[9.1] Availability, cost, performance, and duration of performance
This is a cable controlled arm, a technology that today's major manufacturers largely dismiss and do not actively develop. There is not nearly as much money in selling a metal hook that costs 120 CHF to build for 1200 CHF and that remains largely care free if built right, than there is in selling cheap myoelectric electronics of a total of around 300 CHF for 30'000 CHF and selling all the support that goes with it. Even a rechargeable battery for a prosthetic arm costs around 700 CHF. If a German prosthetic parts manufacturer such as Otto Bock is able to buy themselves a showroom at Berlin's prime address - Potsdamer Platz - then one can derive with closed eyes that our insurance money paid for that - rather than for the engineering we'd really need to wear on our arms.
This is an arm that is available 24/7. No batteries, no recharging, no jittering or interference, no electrode issues. The force is transmitted in a graded way - so I can handle delicate objects just as carefully as I set my mind to it. The fit is almost perfect and definitely comfortable, the elbow is not restricted by painful socket rims, the cable/harness is a minimal setup and materials are chosen to be extremely carefree and easy to wear and clean. There is no way the combination of price, function, comfort and weight can be beat by many other technologies today and not within any foreseeable future.
If you are interested in more work related and difficult work applications, comparing body powered and myoelectric arm technology, here is an informative summary [link]