Aids to use for upper limb function for cancer patients.

Project  / Project number: SO23/20  /  Status:

+3

The challenge

  1. Up to 19% of cancer patients may suffer from Metastatic Spinal-cord Compression MSC), leading to them being bed bound.Macmillan have funded work to help these patients.
  2. The objective was to provide a range of activities on a transportable board that would fit on tables used with ward beds, as well as conventional floor-based tables.
  3. On discussion with the OT personnel involved, designs based on earlier boards (REMAP SO29/19; Aids to rehabilitation of upper limb function for intensive care patients) seemed appropriate.
  4. Ideas additional to/instead of those on the earlier boards were requested.
  5. The system must be safe, easy to maintain, and readily cleaned.
  6. Where possible the actions should have some way of measuring the patient’s degree of achievement, so that they could assess their changes in ability.
+3

The solution

To accommodate all activities requested, two boards were made.  Each board was from 12 mm MDF, and was 400mm high x 550mm wide, and base width 300 mm. Dimensions were dictated by the size of over bed tables. Ideally the base of the MDF boards should be 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, and the final paint finish was durable and washable.

Board 1 has 4 activities:

 

A Yale lock mounted on a mini-door, with attached key.

Three lengths of cord (4 mm diameter) for plaiting and knot tying.Conventional fibre cord could not be used because of difficulties in cleaning this material, so silicone rubber cord was sourced for this purpose.  The cord was found to work very well in tying knots. An acetyl post (about 15 mm diameter) was attached to the board to allow hitches of different types to be tied.

A conventional long reach pad lock, attached to a plastic bar

A vertical Perspex tube, down which table tennis balls could be passed (as requested by the OTs).

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 task.  This sheet will be laminated by the OT staff, so that it can be readily cleaned, and reused.

Board 2 has 4 activities:

  1. For wrist action, a rotating large plastic knob (circa 80 mm diameter) attached to a spring was used (I eventually wound this spring myself to obtain the desired properties). 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 dial operates in both clockwise and anti-clockwise directions.  The spring and rotation mechanism have a rear cover to prevent possible trapping of patient fingers.
  2. Demountable note board; the pen and eraser are housed in a plastic pot attached to the front base.The patient can remove the board to write if more comfortable for him/her.  This feature was requested by the OT.
  3. A series of 3 non-latching spring-loaded switches of increasing strength, that are linked to an LED and battery circuit, as requested by the OT.This unit involved considerable effort to design and construct, as no such commercial unit is available.  In the final design, a pivoted PVC bar was pushed down against one or more springs to activate a microswitch.  See Picture 3. The body of the unit is made from Perspex (PMM).
  4. The fourth activity involves linking electrical connecters, an activity commonplace in the modern home. Included are a mains plug and sockets, USB connector and plug, and an audio lead.  This feature was requested by the OT.

The benefit

Initial feedback has been good, with patients being able to readily understand and use the different activities.  The headline image shows Board 2 being used by a patient.

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