Authors: (including presenting author): :
Wong SY (1), Lam WT (1), Chan KL (1), Ma WL (1)
Affiliation: :
(1) Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital
Keyword 1: :
Occupational Therapy
Keyword 2: :
Prosthetic and Orthotic
Keyword 3: :
Upper Limb Amputation
Keyword 4: :
Myoelectric Prosthesis
Keyword 5: :
Multidisciplinary Rehabilitation
Introduction: :
Upper-limb amputation fundamentally disrupts occupational identity. The loss of bimanual coordination makes routine Activities of Daily Living (ADLs) physically exhausting and cognitively demanding, often leading to dependency and social withdrawal. While traditional myoelectric models (e.g., Ottobock) offer functional restoration, their prohibitive pricing remains a significant barrier to accessibility. The Ohand provides a disruptive alternative, costing less than one-sixth (1/6) of traditional high-end versions, thereby democratizing access to advanced prosthetic technology. However, successful integration relies on a specialized OT-P&O synergy to bridge the gap between affordable hardware and functional independence.
Objectives: :
To evaluate Ohand candidacy criteria and describe a multidisciplinary protocol for EMG signal training, socket optimization, and home-based functional integration.
Methodology: :
Three patients with varying clinical profiles were assessed using a collaborative OT-P&O framework:
1. Clinical Screening & Mapping: Evaluation of stump length, skin condition, and proximal muscle power. Joint biofeedback sessions mapped optimal EMG sites to ensure reliable sensor-skin contact.
2. Selection & Fitting: P&O-led socket optimization was paired with OT-led sensor placement to ensure comfort during dynamic movement.
3. Graded Training Protocol:
Phase I (Isolation): Software-based biofeedback for muscle control without co-contraction.
Phase II (Prosthetic Control): Mastering proportional control and grip patterns.
Phase III (Functional Drills): Repetitive grasping of objects with varied textures/weights.
4. Home Integration: Home visits identified environmental barriers; P&O performed dynamic socket adjustments while the OT implemented task modifications for high-priority ADLs.
Result & Outcome: :
The OT-P&O collaboration facilitated successful outcomes in two out of three cases. Case 1 (33F, Above-Elbow) achieved independence in childcare and home-making within 8 weeks, aided by earlier procurement due to lower costs. Case 2 (65M, Above-Elbow) demonstrated that with joint OT task modification and P&O socket refinement, even "long-stump" candidates can utilize the Ohand effectively. Conversely, Case 3 (60F, 4-Limb Gangrene) was deemed unsuitable due to insufficient clearance post-Krukenberg procedure and weak EMG signals. These findings suggest that the OT-P&O partnership is vital in preventing "prosthesis abandonment" by matching device mechanics to patient physiology. At less than one-sixth the cost of traditional alternatives, the Ohand—supported by this graded multidisciplinary protocol—serves as a life-changing tool for restoring occupational self-efficacy and bimanual independence.
