Rehabilitation for Bilateral Amputation of Fingers

Abstract

We describe reconstructive surgeries, therapy, prostheses, and adaptations for a patient who experienced bilateral amputation of all five fingers of both hands through the proximal phalanges in January 1992. The patient made considerable progress in the use of his hands in the 10 mo after amputation, including nearly a 120% increase in the active range of flexion of metacarpophalangeal joints. In late 1992 and early 1993, the patient had "on-top plasty" surgeries, in which the index finger remnants were transferred onto the thumb stumps, performed on both hands. The increased web space and functional pinch resulting from these procedures made many tasks much easier. The patient and occupational therapists set challenging goals at all times. Moreover, the patient was actively involved in the design and fabrication of all prostheses and adaptations or he developed them himself. Although he was discharged from occupational therapy in 1997, the patient continues to actively find new solutions for prehension and grip strength 18 yr after amputation.

Moving Toward 2017: Progress in Rehabilitation Intervention Effectiveness Research

“…The remaining neurorehabilitationrelated articles spanned a diversity of topics. Three assessed the effectiveness of creative adaptive devices for improving function (Carver, 2009;Glasgow et al, 2012;Stapanian et al, 2010), and another examined the use of gel pads to prevent pressure sores (Thorne et al, 2009). Hall et al (2013) evaluated whether a conservative approach to treatment of carpal tunnel syndrome would reduce surgical intervention and found that patients in the conservative intervention group reported greater symptom relief.…”

“…An additional scoping review (2%) was performed by Hand et al (2011). A total of 15 articles (36%) described single-subject or case designs that used 2 or fewer participants (Beckelhimer et al, 2011;Carver, 2009;Ciro et al, 2013;Earley et al, 2010;Hardy et al, 2010;Henshaw et al, 2011;Hermann et al, 2010;Jack & Estes, 2010;Preissner, 2010;Rowe et al, 2009;Skubik-Peplaski et al, 2012;Sledziewski et al, 2012;Stapanian et al, 2010;Wu et al, 2011;Zlotnik et al, 2009). See Table 3 for additional information regarding participant numbers for the studies reviewed.…”

Rehabilitation, Disability, and Participation Research: Are Occupational Therapy Researchers Addressing Cognitive Rehabilitation After Stroke?

“…Only 1 stroke effectiveness study specifically addressed a different area of impairment poststroke-cognitive dysfunction (Rand, Weiss, & Katz, 2009). The remaining effectiveness studies (n 5 5) involved hand injury (Hall, Lee, Page, Rosenwax, & Lee, 2010;Stapanian, Stapanian, & Staley, 2010), arthritis ( Jack & Estes, 2010), lymphedema (McClure, McClure, Day, & Brufsky, 2010, and acute care rehabilitation (Thorne, Sauve, Yacoub, & Guitard, 2009). Although collectively, the studies related to rehabilitation, disability, and participation published in AJOT during this period demonstrate that occupational therapy researchers are producing evidence, some concerns need to be addressed related to becoming evidence based in this practice area.…”

“…Of the 20 effectiveness studies published by AJOT in 2009 and 2010 related to rehabilitation, disability, and participation, nearly half (n 5 9) were case studies (Carver, 2009;Earley et al, 2010;Hardy et al, 2010;Hermann et al, 2010;Jack & Estes, 2010;Preissner, 2010;Rowe et al, 2009;Stapanian et al, 2010;Zlotnik et al, 2009). Moreover, 4 studies had <10 participants per intervention group evaluated (Giuffrida et al, 2009;Hall et al, 2010;Hayner et al, 2010;Rand et al, 2009).…”

“…More than half of the rehabilitation, disability, and participation effectiveness studies reported in AJOT in 2009 and 2010 (n 5 11) used impairment-level measures as their primary outcome measures (Earley et al, 2010;Fong & Howie, 2009;Giuffrida et al, 2009;Goverover et al, 2009Goverover et al, , 2010Hall et al, 2010;McClure et al, 2010;Nilsen et al, 2010;Rand et al, 2009;Stapanian et al, 2010;Thorne et al, 2009). Impairment associated with any disorder, disease, or condition must be addressed in some capacity during rehabilitation to improve participation; however, the unique contribution of occupational therapy practitioners to the health care community is their focus on everyday life participation.…”