Board 1 (LHS) and Board 2 (RHS)
To enable physiotherapists to provide a range of upper limb motor skill exercises. This is for patients in hospital, needing to learn or re-learn skills necessary for them to have a greater level of independence. The details of these exercises were established by meetings between the Remap member and physio-therapists at the Southampton General Hospital.
The size of the tables that fit to a bed really defines the size of board that could be used- 400mm high x 550mm wide. On reviewing possible options, it was decided to develop two boards, one with low effort actions (e.g. micro manipulative skills) and one with moderate effort options (e.g. wrist rotation), as there was not enough room on a single board to fit all options. The base of the MDF boards were fitted with anti-slip mats (clamps could be used if needed) to provide a positive fitting to the table. All corners and edges were rounded. Final paint finish: white bathroom satin washable.
Board 1 has 6 activities:
- Yale lock mini door, with key on a chain. Also included on the mini door is a sliding safety lock.
- Three lengths of cord (4 mm diameter) for plaiting and knot tying. Conventional cord could not be used because of difficulties in cleaning this material, so silicone rubber cord was sourced for this purpose. Initially I was concerned that the cord may slip and not tie effectively. However, it was found to work very well. An acetyl post (about 15 mm diameter) was attached to the board to allow hitches of different types to be tied.
- Threaded plastic block with 3 sizes of bolt, with each attached to the board by a length of chain. Bolts (6, 10, 12mm diameter) were of nylon and fitted into a threaded Perspex block attached to the board.
- A series of plastic strap clips (pinch action to open) of differing size. Again, conventional woven webbing could not be used because of concerns over microbial contamination. Instead, lengths of silicone rubber sheet (1.5 mm thickness) were cut to the correct width and attached to the clips using brass rivets. The set of straps was loosely held on the board with two vertical PVC bars with cut outs milled in position to allow the straps to slide along
- A set of carabineers of differing size and spring strength were attached to a 5mm diameter aluminium rod supported between two posts attached to the board.
- An analogue watch was attached to the board for patients to practice setting time and date (small scale manipulation skills).
A custom sheet was produced which included illustrations of a range of knots, and a table to allow Individuals to mark their progress with the tasks. This sheet will be laminated by the OT staff, so that it can be readily cleaned, and reused.
Board 2 has 4 activities:
- For wrist action, a rotating large (circa 80 mm diameter) plastic knob attached to a spring (see picture of spring below for view from rear showing mechanism) was used. The further the knob is rotated, the more the effort required. There is a coloured graduated scale with numbers to monitor progress. Note maximum torque required is about 0.8 Nm. The spring and rotation mechanism have a rear cover to prevent possible trapping of patient fingers.
- Grip strength. As a commercial unit was not readily available, a simple device was built by connecting a pressure gauge (0-1 atmosphere) to a flexible rubber bulb by tubing. Squeezing the bulb gives a response on the gauge proportional to the hand pressure.
- A series of 3 springs of increasing strength with attached chains for vertical pull practice. Positive latching was provided by a set of acrylic posts on the board. Springs were contained in short lengths of plastic tube to help prevent any tangling. Note that springs were vertical with any force used thus being directly down on the surface of the table.
- A 3 mm diameter stainless-steel wire formed into a series of sharp bends going up and down and then left to right, with a connected handle and metal loop. This exercise is to practice upper limb movement.
Spring at Rear of Board
A board specific custom sheet was prepared, similar to that used for Board 1.
5.Effort and costs involved.
Costs are to be obtained from the NHS for this project
Consumables, travel and specific items (lock, paint, silicone rubber products, pressure gauge etc.) came to £106.75. Additional minor items (screws etc.) were sourced from my workshop.
On average each activity took about 9 hours to design, prototype, test and finally manufacture, plus 3 hours for each of the two MDF boards (cutting, routing, construction and painting). Discussions with the OT involved and her colleagues circa 6 hours. Most trips to the hospital were by cycle, but travel costs for delivery of each board by car have been included in the. Travel time was about 3h.
Thus, the total time taken on the project was about 105 hours.
Remap Member designing and manufacturing this project ………………… Peter Statham