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?<\/p>\n
[this is comprehensive, it really is – this time there are lots – and I mean *lots* – of images – puhleeze<\/em>, wait until they are loaded, get a drink, go to the bathroom, whatever, *then* read]<\/p>\n <\/p>\n 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!<\/p>\n 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<\/em> 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:<\/p>\n 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.<\/p>\n 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.<\/p>\n So the time has come for a comprehensive<\/em> inventory of ADL<\/em>. 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 ;-)<\/p>\n [work in progress \/ more details following]<\/p>\n Contents:<\/strong>\n
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