Training the Unilateral Amputee Upper Extremity
Leonard P. Madison *
Begin with "Unilateral Thinking." Concentration on Terminal Device only is important. Among the first exercises are: 1. Opening and closing of the terminal device; 2. Picking up small nails or tacks from table top: 3. Picking up blocks and a ball from table top.
Next allow the patient to help choose interesting objects on the training board ( see illustration) which will exercise his opening and grasping ability. The following are examples: I. Pulling light switch : 2. Turning light button: 3. Unfastening snaps; 4. Tug of war with string.
Next have the patient practice on operating latches. He already has the idea of opening and closing the hook. Now he learns to position the hook. Also, in operating latches which need finger compression and pulling action, he will learn tension arm action. (1. Kitchen Cupboard Latch. 2. Window Casement Latch, 3. Hook and Eye. )
A little trick training should now he used to teach the amputee to think of different methods of attacking a problem when his first try does not work. This stresses positioning of the hook and use of the hook with the fingers closed. Exercises include: 1, Opening drawers: 2. Operating suit-rase latches: 3. Operating push type light switches: 4. Operating water faucet.
During all this training with the terminal device alone, the prosthetist has an opportunity to check the harness setup which he has designed for the patient. He can observe whether the harness is permitting the patient to operate the terminal device smoothly. If there is need for adjustment it will show up while the patient is doing these procedures. It is for this reason that it is wise to do this much of the procedure of training when the patient is in for rough fitting and is wearing the arm in "rough fitting" condition.
Continue with "Bilateral Thinking." Emphasize coordination of the appliance and the normal arm. It is suggested that this phase of the training be done in a second lesson perhaps at time of the final fitting.
Have the patient do the following to learn simple coordination first: 1. Operate loose zipper; 2. Pick up box and remove marbles; 3. Remove matches from penny match box; 4. Open box and work padlock; 5. Put blades in injector razor: 6. Pencil sharpening.
The following operations teach the patient to make use of additional articles to aid himself: 1. Dialing telephone ( use aid of pencil in terminal device) ; 2. Using button hook: 3. Filling lighter: 1. Opening jar and measuring coffee: 5. Using knife, fork: 6. Opening cans or bottles.
Give the patient a list of things to work nut at home. When he comes in to your office, check on his progress and help him further with problems which proved most difficult. In turn, ask him to pass on to you any new Uses for his terminal device which he has discovered so that you may pass on this benefit to other beginners.
The following exercises are suggested for training the woman amputee: 1. Use of a dishmop: 2. Ironing: 3. Peeling potatoes.
In training children they should be encouraged to work with construction toys and building blocks. A favorite exercise is eating candy from which they must first remove the paper wrapping.
The Madison Training Board
Training Helps Using Two Hands
(this list of "home practice" work is given to the patient after he has completed the basic training)
- Open Box.
- Open & close zipper. Measure with tape. Unlock padlock. Sharpen pencil. File nails. Unwrap candy. Open can or bottle.
- Remove money from purse or wallet. Remove cork or cap from bottle. Remove top from tube of tooth paste.
- Thread needle.
- Start nail into board.
- Tie bow, necktie or shoelaces.
- Remove and wind wristwatch.
- Work bent-nail puzzle.
- Peel potatoes.
- Tie millers knot.
- Iron clothes.
- Use bottle with medicine dropper,
- Place new blades in Injector razor.
- Repair extension cord.
- Eat grapefruit or melon.
- Remove lid from jar.
- Measure instant coffee into cup
- Fill fountain pen.
- Use book matches.
- Use band bottle opener.
- Unwrap articles (cigarettes).
- Wrap packages