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Thread: Grip

  1. #1
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    Grip

    I was wondering if anyone with no hand movement ever used equipment to make a fist to grip better...

    Has anyone ever heard of the spring steel gloves that motorcyclists use to keep their fingers wrapped around the handle bars? Someone mentioned that to me but I couldn't imagine they would be very ideal for those with no fingermovement...but who knows!

    Other than that, I was thinking about making a glove or device for my boyfriend who cant use his hands, but is learning how to use tenodesis. . I assume they already have these things...but at therapy he hasn't found anything that he likes yet so that led me to believe that maybe there is room for improvement regarding equipment like that...

    Is there anything that you wish your adaptive equipment did that is doesn't do?

  2. #2
    A custom made dynamic tenodesis (wrist driven extension splint) would be the most appropriate splint IF he actually needs it. From my understanding he is still in rehab, so has quite a bit of potential to strengthen his existing tenodesis, and may not need a functional spint for this. To really work, they need to be custom made, as they can cause skin breakdown otherwise, and will also be less than functional if ill-fitting. Many people do not like how "disabled" these devices make them look, and of course you need to learn how to don and doff it yourself for it to really be functional.

    Most people who are indeed intact at C6 do not need these. They are used more by those who are very weak in C6 or actually C5.



    What is his actual motor grade for his wrist extension right now? Any triceps or wrist flexion?

    (KLD)

  3. #3
    Quote Originally Posted by SCI-Nurse View Post
    A custom made dynamic tenodesis (wrist driven extension splint) would be the most appropriate splint IF he actually needs it. From my understanding he is still in rehab, so has quite a bit of potential to strengthen his existing tenodesis, and may not need a functional spint for this. To really work, they need to be custom made, as they can cause skin breakdown otherwise, and will also be less than functional if ill-fitting. Many people do not like how "disabled" these devices make them look, and of course you need to learn how to don and doff it yourself for it to really be functional.

    Most people who are indeed intact at C6 do not need these. They are used more by those who are very weak in C6 or actually C5.



    What is his actual motor grade for his wrist extension right now? Any triceps or wrist flexion?

    (KLD)
    I don't think that dynamic tenodesis splints are amenable to C5 tetraplegics as they lack C6 innervated wrist extensors to drive the splint.

  4. #4
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    bioness makes functional electric stimulation gloves that have a button on the bottom to use them for a functional grip.as you move forward in your recovery if return is elusive tri-pins work well on steering wheels and many other uses.

  5. #5
    Senior Member Kulea's Avatar
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    To have a tight grip to really hold things, something like this
    http://www.activehands.co.uk/
    works well. But, for day to day activities, like holding a glass, or picking up a sandwich, there really isn't anything that is convenient and practical. I got those tenodesis splints out of rehab (they are only really good for pinch and suck at holding things in the palm). I used them for writing and, when I finally ditched attendant care, for putting on my condom cath and attaching the leg bag tubing and straps. It was holy freedom when I discovered that I could actually do those things without the splint. Using your hands as much as possible strengthens what little you have and greatly increases the coordination. Any C6 that doesn't let their fingers curl up beyond usefulness, should easily be able to hold a full glass (or can of beer) in one hand. But, I also am a huge advocate for modifying your environment. One needs to try out a lot of different cups to find out what works best. Maybe at first a tall mug with a handle. Maybe a thinner plastic cup than a glass. Maybe a cup with a rim (like disposable plastic cups). The point is that you continually work to optimize your environment for your current abilities. The more you work to hold things unaided, the more things you'll be able to hold.

    You also look for ways to modify how you hold things and how you use other things besides your hands to assist. Like when I use a scissors. I use my lap to support the bottom of my hand while I bring my wrist down which causes the thumb to push the scissors closed. Or to pick up a coin, I push it against my tire. Or, you learn to hold things with two hands rather than one. Or, you use your teeth a lot (like when I open twist offs). You would be really surprised how few times you really need to grip anything. Even difficult jars can be opened without grip.

    I have been an avid woodworker and have done pretty well without gripping aids (although those activehands would probably make hammering nails easier than my method). I used to go out sailing almost every day and was able to hold and pull the rope and control the tiller without "grip". I pick up phone books off the ground without grip. I cook and cut and clean dishes without grip. I'm not saying I wouldn't want grip. But I find very few times where it would be worth the hassle of putting on some kind of glove thing.

    So, I don't want to be too patronizing here. I REALLY appreciate that you and your boyfriend are very concerned about HOW he will do things in the future. But, where there is a will, there is a way. And almost NO progress is made while in rehab. The therapists don't have the time to develop technique, so they look for "solutions". You have a huge deficit in strength and coordination that only comes back through practice over time. And, more importantly, there is no IMMEDIATE need in rehab. But, once you get into the world and are forced to confront how to get things done, you figure it out, and if you need to, you get some tool to assist you. I gained more functional ability in the first couple weeks just after rehab than all 4 months I was in.

    But, if I could advise you on how you should be spending your energy now, don't focus as much anxiety on the little things like writing and grip, all of those things will be answered over time. But, right now, while you have the experts, work on the big things. Like strength, balance and stamina and ask the therapists about how to do things that he currently can't do. Like what are ways to transfer independently without a transfer board. Or, if he falls on the ground (which WILL happen), how can he be assisted back in the chair by someone small. Or, how can he get back in the chair by himself (I can do that now, too). Even if they don't think it would be possible, it's good to know. I would spend every free moment they let me in PT, because every minute amount of function you can get back now (function is much easier to regain sooner than later and is often a matter of strengthening the smaller muscles that you still have but don't realize you have) will pay off huge in the future. And in OT, I would spend all the time working on coordination activities with my hands (like let's spend time trying a lot of different ways one might hold a fork without a cuff or use a key in a regular keychain, even if he can't do it now) and learning about daily care and hygiene concerns. And, while I know it felt really stupid at the time, doing things like playing chess and playing cards by holding them in your hand (even when you drop them a few times) works wonders. Anything that forces you to use your hands rather than hide them or compensate is good. And get over the need to be good at something in order to work at doing it. He will be a complete failure at doing most of the things he used to take for granted. And, so what? Do them anyway. A magician probably dropped the deck of cards thousands of times before he perfected his slight of hand. And that perfection relied on practicing just the littlest movements in his hands.

    I'm not saying don't care about the little things. Like if the OT can demonstrate how to button a button with the loop thing, that is cool. It's just that the things that you might be REALLY worried about now, might, in reality, not really be that big of a deal in the real world. And things that none of the therapists warned you about, will be HUGE. When the need arises, there are answers. But, until that need comes, live in the now. Focus on caring for one another and staying happy, and healthy and determined.

    Oh and I'm not trying to get you to stop asking questions. Your questions are good and it is amazingly wonderful that you ask them. I'm just offering additional thoughts, because I've lived a pretty darn good and blessed life and hope I can be of some benefit to ease you through the transition.
    C-6/7 incomplete

  6. #6
    Senior Member Kulea's Avatar
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    Sorry to be spewing too much crap, but I just realized what you were really asking. Here's my answer. For a quads, life is one big hassle. Everything takes longer and you are constantly mentally dealing with the routines of life, very little is on auto-pilot. So, anything that is a hassle to use, anything that ADDS to the hassle of life, is crap. It is that simple. Anything that can't be instantly put on is a hassle. Like, I have a velcro strap on the back of my hairbrush. That's great, because it takes half a second to slip my hand in and use the brush. And it is already on the brush that I would be using anyway. But, if I had to slip my hand into some kind of glove, ESPECIALLY if it had fingers, that would take me many minutes just to put it on. Too much hassle. The hassle only becomes worth it if the task it is needed for is for an extended time, or is REALLY important and the glove thing is the only way to do it. Like I wore quad gloves for pushing a chair. First, they didn't have fingers so I could put them on pretty quickly. I needed them on for extensive periods and pushing without gloves tore up my palms. So, while they were a small hassle, they were worth it.

    So, you have to really think like a guy who can't use fingers, can't even hold them straight. It's not so much about what could he use the device for, the first and most important question is whether the device is practical to use at all. (I am an engineer by training, and an inventor of sorts, so that's where I come from). Like, you have to think through the process of using the device at least as much as the benefit of having the device.

    So, I am always on the lookout for things that make life simpler, not necessarily easier. I like things that reduce the hassle of what I want to do. THAT is far more beneficial to my life than improving my function.
    C-6/7 incomplete

  7. #7
    Thanks for the referal for Active Hands Kulea. I'm glad you are getting good use from your grips still. Our grips help you hold things when finger stregth is a problem but will not help to improve your grip. There are some aids out there by a company called Saebo I think who make an aid mostly for those who have suffered strokes to exercise finger strength with resistance but it may or may not be what you are after. If you want to hold cups/beer bottles, etc we can make a longer over hand strap version for you as a one off. Contact Active Hands through the e mail address on our website if you need that. Cheers,

    Rob.
    info@activehands.co.uk
    Rob Smith
    C5/6 incomplete SCI
    Founder of Active Hands gripping aids. Improving independence for people with weak hand function.

  8. #8
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    Kulea, you stated everything that I would have said, but I believe that you stated it so much better. Quads need to be creative, persitent and patient [everyday ADL's usually take more time to complete] to maximize and maintain any independence which we acquire. Trial and error often leads to an amenable solution. Rehabilitation really does occur in the home after discharge from the medical facility.

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