Suitable Candidates

The i-Limb hand is suitable for individuals with upper limb absence, at or proximal to the wrist.

It is essential for the individual to have viable control sites. Potential control sites should be assessed for suitability during a thorough myo-testing process. Refer to Myo-testing in Resources section, for detailed instructions on how to complete myo-testing and training.

Individuals should be motivated to learn to use the prosthesis and have clear functional goals of how to incorporate it into their day to day activities.

Individuals should have realistic expectations of the effort involved to learn to use a prosthesis.

Achieving optimum performance requires:​

• Patience​
• Effort​
• Time and training

Expectations

At initial assessment, it is essential that the Therapist and Prosthetist educate the user and fully understand their expectations, needs and goals.

To understand user expectations open-ended questions should be asked:

• 'Tell me what you understand of the i-Limb hand?'
• 'How do you think the i-Limb hand will help you?'
• 'What will be your main uses for the prosthesis?’

Failure to address expectations and educate on the benefits and challenges of wearing a prosthesis can lead to difficulties during the fitting and training process.

It is important for the user to understand that the i-Limb hand is not a replacement for a natural hand, but instead a tool to allow functional tasks to be carried out more effectively. Aspects of the prosthesis which should be discussed include; function, weight, appearance, fit, noise, lack of sensation etc.

Having a staged approach to training is important to ensure the user is not overwhelmed when learning to use their prosthesis.

Goal Setting

Setting realistic and manageable goals with the user is important.

Goals must be jointly agreed between the user and the clinicians.

Goals can be short-term and long-term and must be SMART: Specific, Measurable, Achievable, Realistic, Time-based.

Examples include:

• ‘To be able to tie my shoe laces within one week’
• ‘To be able to prepare and cook a meal within one month’

Jointly agreeing goals is the best way to integrate the prosthesis into activities of daily living. It allows the most beneficial grips to be programmed on to the i-Limb hand and supports goal based occupational therapy training.

Occupational Therapy Training

The Occupational Therapist is a key member of the upper limb multi-disciplinary team. They are responsible for maintaining focus on functional goals and supporting the user on the best ways to integrate their prosthesis into their day to day life.

Therapy training is person centric, focusing on personal goals, lifestyle and interests.

Optimum user outcomes are achieved when the Prosthetist and Therapist work closely together with the user.

Studies support the inclusion of Occupational Therapy in upper limb prosthetic fitting.

• Early therapy nearly doubles the rate of daily use. Fletchall, S. “Returning upper-extremity amputees to work”. The O&P Edge. 2005; 4:28-33.
• Research suggests skilled, individualised therapy with the prosthesis takes an average of 20-30 hours. Resnik, L. Meucci, MR, Lieberman-Klinger, S, Fantini, C, Kelty, DL, Disla,R, Sasson, N. “Advanced upper limb prosthetic devices: Implications for upper limb prosthetic rehabilitation.” Arch Phys Med Rehabil. 2012; 93: 710-717.
• A study on the transition from traditional upper limb prosthetics to multi-articulating hands. V. B. MacEachen, F. Davie-Smith, and B. Carse, “Comparison of patient-reported and functional outcomes after transition from traditional upper limb prosthetics to multi-articulating hands in the user with a unilateral trans-radial amputation, ”Prosthetics & Orthotics International, vol. Publish Ahead of Print, Jul. 2022.