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Section 2: Upper Limb
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Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
362
Chapter 30
Upper Limb Adaptive Prostheses
for Vocation and Recreation
Robert Radocy, MSc
Abstract
Adaptive prostheses have evolved substantially over the past 30 years, becoming a viable and
cost-eective solution that meets the challenges encountered by many users of upper limb
prostheses. Adaptive prostheses include technologies for both recreational and vocational
applications. Various factors have caused the growth in this area of prosthetic technology, including changes in the Healthcare Common Procedure Coding System. In many
instances, adaptive components require very sophisticated, high-performance or unusual
prosthetic designs that emphasize function and biomechanics over appearance. A wide
variety of quick-disconnect devices, vocationally oriented tools, and domestic implement
devices are now available for patients. A broad array of sports and recreational adapters
provide the opportunity for patients with hand absences to participate and be competitive
in activities ranging from archery to kayaking to weight liing. Specic adaptive solutions
for many activities are explored in detail. Contributors to this growing eld of technology
are identied and various references and resources provided.
Keywords: activity-specific prosthesis; adaptive prosthesis;
prosthesis; sports and recreation; upper limb; vocation
Introduction
The adaptive or activity-specific prosthesis for an upper limb absence is typically designed to fulfill limited tasks
and activities but with a higher level of
performance. The term activity-specific
replaced the general reference for sports
and recreational prosthetic adaptations
in the late 1990s. An activity-specific or
adaptive prosthesis has a broad definition that references both vocational and
avocational designs. This type of prosthesis can differ from a traditional prosthesis in various ways. In most instances,
the activity-specific prosthetic limb and
distal component (or terminal device)
focus on a targeted function. Replicating
Mr. Radocy or an immediate family member is an employee of erapeutic Recreation Systems
or services), commercially derived honoraria, or other non-research–related funding (such as paid
travel) from TRS; and serves as a board member, owner, ocer, or committee member of Association
of Children’s Prosthetic and Orthotic Clinics.
correct human hand or upper limb anatomic features is not the primary goal in
these components. Rather, the design
emphasis is on duplicating precise upper
limb biomechanics and, in many cases,
high-performance function. These prostheses are designed and constructed to
enable the user to achieve higher levels of
competency and performance in specific activities in which neither traditional
body-powered nor externally powered
prostheses can functionally, realistically,
or reliably perform.
Early commercial designs for activityspecific terminal devices such as the
Bowling Ball Adaptor (Hosmer) and
Baseball Glove Adaptor (Hosmer) date
1
back to the 1950s. Between the 1950s
and the early 1980s, no substantial efforts were undertaken to develop the
market for activity-specific devices, except for a prosthetic golf terminal device
that was built on a limited basis. Most
commercially available, innovative, activity-specific prosthetic adaptations
were introduced in the 1990s. In the
early to mid 2000s, the demand for
high-quality, commercially built, adaptive devices began to increase. Published
articles and educational textbooks on
activity-specific prosthetic technology
are somewhat limited, but relevant literature is available.
Several motivating forces have contributed to the development of activityspecific prostheses. Beginning in the
1970s, physically challenged individuals became more visible to the public as
they began to engage in athletic activities
such as snow skiing. Simultaneously,
college educational programs began to
develop disciplines such as adaptive
sports and therapeutic recreation, resulting in professionals trained with an
academic focus in these areas. Concurrently, many patients with upper limb
absences began demanding prosthetic
devices to improve their capabilities
to return to participation in activities
performed before amputation.9 During
this period, the psychologic values of
reimmersion into sports and recreation
activities in the rehabilitation scheme
of those with a limb absence began to
develop.
In the 1980s and early 1990s, several commercial businesses were formed
to manufacture and sell standardized,
2-8
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
363
Section 2: Upper Limb
activity-specific prosthetic components.
Some of these designs were oriented toward adaptive sports and recreational
technology, whereas others were targeted to provide specialized hand tool
attachments and implements for domestic use. Both types of technologies
were designed to enhance the functional
capabilities of prosthesis users, allowing them to be more competitive in
two-handed tasks.
The evolution, growth, and popularity of national sports organizations for
the disabled, including Disabled Sports
USA, the National Amputee Golf Association, and Physically Challenged
Bowhunters of America, have increased
interest in adaptive prosthetic technologies. Similarly, specialized competitions
and games for physically challenged
athletes have further contributed to the
growth and interest in activity-specific
prostheses. The Paralympics gave credence to the athletic movement for the
physically challenged and increased
interest in activity-specific or adaptive
prosthetic technologies.
Improved representation and exposure for amputee athletes and amputee
role models via national organizations
such as the Amputee Coalition of
America and the Challenged Athletes
Foundation have further expanded information and communication between
prosthesis users interested in athletic
pursuits and new adaptive technologies.
Simultaneously, the rapid expansion of
communication, information, and data
via the Internet and social media have
expanded and created interest in new
prosthetic technologies.
More recently, the demands placed
on US military rehabilitation hospitals
by young, strong but physically trau
matized military personnel returning
from the wars in Iraq and Afghanistan
played an important role in the development of new and innovative designs
for prostheses. These facilities created
state-of-the-art programs that actively
integrated sports reconditioning into
comprehensive rehabilitation programs
for military personnel.
Insurance companies began to recognize the health values and psychologic
benefits of adaptive prosthetic technologies in rehabilitation. Reimbursement
for activity-specific or adaptive upper
limb prosthetic technology has expanded and improved, but it still is not adequate for those with a limb absence.
In 2009, the Healthcare Common
Procedure Coding System (HCPCS) created the L6704 billing code to provide
coverage and reimbursement for terminal devices designed for specialized
work, sports, and recreational activities.
Creating this code was an important
step for HCPCS in recognizing the importance and value of activity-specific
or adaptive prosthetic technology in the
overall rehabilitation of patients with an
upper limb absence.
Cost and affordability are factors related to the use and increasing number
of activity-specific prostheses. At a time
when bionic technologies have captured
the attention of both the media and the
general public, the reality for the prosthesis user is that extremely expensive,
externally powered prostheses are not
capable of reliable performance in most
sports or vocational activities with demanding bimanual skill requirements.
Activity-specific technologies are much
more affordable and typically have
much higher levels of reliable function
and performance in many activities
compared with bionic prostheses. In
addition, an adaptive prosthesis can
complement and augment the capability of a bionic prosthesis user, providing greater longevity to the bionic
prosthesis by offering a substitute for its
use in inappropriate environments and
inadvisable tasks. The activity-specific
prosthesis can be the workhorse for all
physically and functionally demanding
vocational and avocational pursuits,
whereas the bionic or myoelectric limb
can complete other less-demanding but
important user functions.
Prosthetic Interfaces
and Limb Design
Activity-specific prostheses are typically used in high-force, high-stress,
and high-performance environments.
They typically require a socket (inter
face) design and construction that considers secure suspension, residual limb
comfort under both static and dynamic
loads, range of motion (ROM), physical
weight, structural strength, ideal prosthesis length, and prosthetic alignment
relevant to load bearing.
Suspension
Various options are available to achieve
a secure prosthetic suspension, depending on limb morphology. The prosthetic
platform can start with a well-designed,
self-suspending socket that enhances
comfort, with a partial liner encompassing the medial and lateral epicondyles
and olecranon or a polymer locking
liner. Locking liners should always
provide control for longitudinal stretch
in an upper limb socket to maintain secure suspension. A short, residual limb
prosthesis can be enhanced for load
bearing by extending the rear brim of
the socket to distribute load to the back
of the humerus. Socket security can be
augmented with technology that uses
tension system mechanisms. Socket design can pattern any number of proven
technologies or variants, depending on
the patient’s needs and requirements.
Load Bearing and Comfort
The socket interface should be tested
on the patient under both static and dynamic loads to ensure that there are no
localized pressure points that will make
the socket intolerable under dynamic
loading. Certain liners can help cushion
the load, but will not replace a properly modified socket that creates secure
suspension and facilitates movement of
the olecranon and condyles throughout
complete elbow flexion ROM. A well-de
signed socket should provide enough
comfort and security for the patient to
-
10-12
-
Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
364
perform a pull-up or push-up without
causing debilitating pinpoint pain in the
socket.
Physical Weight and
Structural Strength
Typically, a lighter prosthesis is preferred if strength is not sacrificed.
Materials such as woven carbon fiber
fabricated with appropriate, compatible, high-strength carbon-acrylic resins
in both the socket and the forearm of
the prosthesis provide a durable, lightweight limb suitable for most activities.
Prosthesis Length
If necessary, the length of the prosthesis
can conform to that of the normal limb.
Certain load control and biofeedback
benefits can be achieved for the user
by shortening the overall length of the
prosthesis, which moves the terminal
device closer to the residual limb. Using
a shortened prosthesis to provide a more
stable platform for the terminal device
is exemplified in swimming prostheses
(Figure 1).
Chapter 30: Upper Limb Adaptive Prostheses for Vocation and Recreation
Figure 1
TRS, Boulder, CO.)
Photograph show s a short swimming p rosthesis. (Reprodu ced with permission fr om
Alignment
Specific activities, such as archery or
weight lifting, can require that prosthesis alignment be factored into the design
to achieve optimal performance. End
weight bearing and balance are directly
affected by the degree to which the forearm of the prosthesis is preflexed from
the socket. The wrist mounting angle
also affects load bearing and can affect
performance. Typically, a more neutrally
aligned prosthesis (minimal preflexion)
performs better in sports activities in
which a substantial amount of gross
motor motion occurs, because it allows
increased degrees of freedom through
various body zones.
Activity-Specific Vocational
Technology
Direct prosthetic tool and implement
technology is not a recent idea. In medieval periods, some knights and members
Figure 2
interface. (Reproduced with permission from Texas Assistive Devices, Brazoria, TX.)
of royalty who had lost a limb were fitted
with creative prostheses equipped with
an integral dagger or sword. In the 21st
century, this concept has experienced
a rebirth, and the validity and viability of such designs continue to increase
(Figures 2 and 3). In one instance, the
initial inspiration for the development
Photograph show ing some of the working to ols that can be attached to a p rosthetic
of adaptive prosthetic components arose
from an inventor’s passion for cooking
and frustration with being unable to
adeptly handle carving knives. Prototypes were developed for personal use,
and a line of highly functional adaptive
tools was perfected. These devices were
complemented by the development of
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
365
Section 2: Upper Limb
Figure 3
duced with permission from Texas Assistive Devices, Brazoria, TX.)
the N-Abler wrist interface (Texas Assistive Devices) in the early 1990s. That
multifunctional wrist interface connects
Photograph of domestic tools that are attachable to a prosthetic interface. (Repro-
emphasis on designing prostheses that
replicate the natural biomechanics required to perform an activity.
a variety of tools and implements to the
prosthesis, allowing precise flexion and
rotation of the tools and implements
in ways that were not previously possible. These adaptive components are
designed to make the individual’s efforts more productive by expending less
energy and improving efficiency. These
devices help to improve the user’s independence and self-esteem.
Adaptive Technologies
for Specific Sports and
Recreational Activities
Ball Sports
Ball sports can be separated into those
that require either unilateral or bilateral
function. Baseball and softball throwing are primarily unilateral activities,
whereas volleyball or basketball requires
bilateral upper limb participation. Sim-
Activity-Specific Adaptive, Sports,
and Recreational Technologies
The interest in prosthetic sports and recreation adaptive terminal devices has
increased substantially since the mid
2000s. The variety of devices currently
available provides those with a hand
absence not only better access to sport
activities, but in many instances, a solid
platform from which to compete with
two-handed peers. The key to achieving competitive, high-performance capability in sports and recreation is an
ple, flexible, polymer terminal devices,
such as the Super Sport (TRS) and FreeFlex (TRS), simulate the volar surface of
the palm, providing much of the function used in controlling larger diameter
balls (for example, volleyballs, basketballs, and soccer balls) and are resilient
and strong enough to support body
weight for activities such as push-ups
and handstands (Figure 4). These devices function well for both two-handed catching and ball tossing. They also
provide a safe interface at the end of the
Figure 4
and Free-Fl ex terminal devices that can be u sed
in ball catching and tossing. (Reproduced with
permission from TRS, Boulder, CO.)
Photographs of the Super Sport
prosthesis for contact sports, protecting
both the user and other players from
physical injury.
More advanced prosthetic designs
have been specifically designed for
basketball and volleyball (Figure 5).
The competitive, unilateral throwing of
baseballs, softballs, and similarly sized
sports balls using a prosthesis was made
possible by a prosthetic adapter with an
adjustable, elastomer support arm and
ball-capturing cup system (Figure 6).
Users with a transradial amputation
have the ability to throw a baseball with
control and accuracy at speeds greater
than 50 mph and to distances exceeding
30 yards.
Many ball sports also involve the biomechanics and techniques of catching.
Typically, pronation and supination are
used when fielding and catching a ball.
Fielding a ground ball (catching below
the waist) usually requires forearm supination, whereas fielding a fly ball (catching above the waist) requires forearm
pronation. Using a prosthetic adaptation, such as the Baseball Glove Adaptor
(Hosmer-Dorrance), allows a traditional
first baseman-type glove to be mounted
onto an oversized, voluntary-opening
split hook but does not accommodate
rapid pronation or supination of the device. In the 1990s, The Hi Fly Fielder
(TRS) replaced the traditional glove with
Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
366
Chapter 30: Upper Limb Adaptive Prostheses for Vocation and Recreation
Figure 5
bound Pro Basketball Hand (B) are shown. (Reproduced with permission from TRS, Boulder, CO.)
Figure 7
and yoga. (Reproduced with permission from TRS, Boulder, CO.)
a modified lacrosse stick head and specialized oversized net. The oversized net
allows a ball to be caught either forehanded or backhanded; eliminates the
need for pronation and supination; and
provides a strong, lightweight platform
for catching a baseball or softball. The
Double Play (Texas Assistive Devices)
design is similar, but uses a standard,
lacrosse netting system instead of a dual-directional netting design. This design requires pronation and supination
of the device for various catching and
fielding situations.
Photographs of terminal devices for basketball. The HP Hoopster (A) and Mill’s Re-
Photographs of various models of terminal devices used in tumbling, gymnastics,
Tumbling, Gymnastics,
Floor Exercise, and Yoga
Certain terminal devices can be applied
successfully to tumbling, gymnastics,
floor exercise, and yoga because of their
flexible strength, stability, and resilient,
nonslip surfaces (Figure 7). These devices provide the cushioning, shock
absorption, and other biomechanical
properties required to successfully and
safely perform these activities.
Gymnastic activities that require the
ability to hang and swing are also challenging for those with a hand absence.
Upper limb strength is required, and
Figure 6
ball and softball terminal devices. (Reproduced
with permission from TRS, Boulder, CO.)
Photographs of the Cobra base-
it is essential that the prosthesis is designed to comfortably support the full
body weight of the user. An adaptive
terminal device can allow a gymnast
to perform on the uneven parallel bars
and accomplish more straightforward
exercises such as pull-ups (Figure 8).
Swimming and Pool–Based
Therapeutic Exercise
For those with an absent hand, swimming without a prosthesis is possible,
but swimming with a customized swimming adapter or swimming prosthesis
can improve performance, propulsion,
and therapeutic value by adding resistance to the stroke. The Swim Fin Kit
(TRS) is custom fabricated to fit on the
residual limb without a prosthesis (Fig-
ure 9, A). Such fin-type devices provide
water resistance that can be beneficial
in pool-based therapies in which upper
body conditioning and strengthening
are goals. Other swimming devices require the use of a prosthesis. A short,
lightweight, customized swimming
prosthesis can improve performance
when compared with a full-length
prosthesis for those with mid to short
transradial absence or swimmers with
a transhumeral absence. These devices
rely on a folding-fin or a butterfly wing
design to enhance swimming performance (Figure 9, B). Patients with a
hand absence above the midradial level
have no ability to pronate and supinate
or “feather” a stiff, rigid paddle while
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
367
Section 2: Upper Limb
Figure 8
(Reproduced with permission from TRS, Boulder, CO.)
Figure 9
Swim Fin Kit (B) are shown. (Reproduced with permission from TRS, Boulder, CO.)
Figure 10
TRS, Boulder, CO.)
Photographs of adaptive terminal devices that allow a gymnast to hang and swing.
Photographs of the terminal devices for swimming. The Freestyle Swim (A) and
Photographs of prehensile terminal devices. (Reproduced with permission from
swimming; this can result in exhaustion
from wasted energy. The folding-fin design eliminates the need for pronation
and supination, allowing water to flow
past the device during arm retrieval and
then flare back open during the power stroke. This action conserves energy and improves stroke efficiency by
modulating resistance and improving
stroke volume for increased control, propulsion, and speed in the water. These
prostheses can be modified to conform
to the surface area and displacement of
the swimmer’s hand if required for competition or as a goal for physical therapy.
The concept of a swimming adapter that
modulated water resistance originated
with a Canadian prosthetist.
13
Weight Training and Conditioning
Many children who are born with a
congenital hand absence or an anomaly
are unable to physically challenge their
affected limbs adequately to stimulate
balanced muscular and skeletal upper
limb growth. As these children become
teenagers, many become more conscious
of body image and begin upper limb
training regimens for body strengthening and muscle balance. Other individuals are challenged with traumatic hand
loss and either wish to continue their
pretrauma body conditioning activities
or begin exercise for therapeutic sports
conditioning or body building.
Weight lifting and conditioning prostheses must have a secure, comfortable
suspension; a carbon-reinforced socket
and forearm; and a well-bonded, laminated wrist unit to ensure safe function. The prosthetist should consider a
nontraditional, neutral alignment in the
prosthesis, with minimal preflexion to
enhance control and performance for a
patient with a short- to medium-length
transradial amputation. Wrist alignment
also should be considered to optimize
balancing heavier loads.
Several types of prosthetic technology help patients perform confidently
and functionally in weight lifting,
Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
368
Chapter 30: Upper Limb Adaptive Prostheses for Vocation and Recreation
Figure 11
Lifting Device designed for training with free
weights. (Reproduced with permission from
Texas Assistive Devices, Brazoria, TX.)
Photograph of the Weight
therapeutic resistance exercise training,
and body building. Voluntary-closing
terminal devices can be easily modified
to lock around and onto weight machine
handles, dumbbells, and barbells, but
they are not specifically designed for
weight lifting (Figure 10). Other devices, such as the Weight Lifting Device (Texas Assistive Devices), have been
designed to accommodate the rigors
of training with free weights and cable-actuated stack-weight exercise machines, as well as other types of exercise
equipment (Figure s 11 and 12). These
devices provide stable platforms for controlling heavier weights through a wide
variety of ROMs and body zones and
have performed well in Olympic-level
competition.
14
Figure 12
The Black Iron Master, Black Iron Trainer, and Black Iron Lite terminal devices are shown. (Reproduced with permission from TRS, Boulder, CO.)
Figure 13
with permission from TRS, Boulder, CO.)
Photographs of terminal devices designed for weight training and conditioning.
Photographs of prosthetic adapter terminal devices for golf clubs. (Reproduced
Golf and Baseball
Golf and baseball have parallel biomechanical demands. Both golf and bat
swinging in baseball or softball involve
coordinated, gross motor motions involving the torso, arms, and hands. Creating the appropriate degrees of freedom
in movement and capturing the energy
created in the backswing phase of these
sports are essential to achieve the best
performance.
Historical designs for golf prostheses applied ball-and-socket or universal
joint linkages connecting the prosthetic wrist to the golf club. Other designs
used a direct, rigid attachment to the golf
club. Neither of these earlier approaches
adequately replicated the biomechanics
of a natural two-armed swing. Modern
golf club prosthetic adapters connect the
prosthesis to the grip of the golf club
using a high-strength, flexible coupling
(Figure 13). The flexible coupling or energy-storing body of these adapters provides enhanced flexibility and ROM and
enables the golfer to replicate an accurate, powerful two-handed golf swing.
Transhumeral designs with customized
lengths, such as the Troppman grip
(Troppman Prosthetics), eliminate the
need for a prosthetic elbow and forearm
(Figure 14). This type of design lightens
the prosthesis substantially and creates
a high-energy transfer system that controls the swing. Designs exist for both
right- and left-hand absence, and specific models accommodate either right or
left hand–dominant swing styles.
The powerful, controlled swing of
a bat hitting a baseball or softball requires increasing the degrees of freedom
available through the prosthesis to help
replicate upper limb biomechanics. Secondarily, engaging the bat handle with
a secure but releasable grip is also advantageous. Several devices have been
designed for users with a leading arm
prosthesis (lower hand grip), whereas
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
369
Section 2: Upper Limb
Figure 14
a transhumeral amputation tted with a
custom-length golf prosthesis. (Courtesy of
Phillip M. Stevens, MEd, CPO, Salt Lake City, UT.)
Photograph of a patient with
the Grand Slam (TRS) terminal device
has been designed to provide function
for those with a trailing arm (upper hand
grip) prosthesis (Figure 15). A model
also exists to meet the needs of both left
and right hand–dominant batters. These
adapters facilitate the capture, storage,
and release of energy. Energy is created
by the bat’s mass and momentum during
the rear swing phase of the bat swing cycle and released through the prosthesis.
Archery and Bowhunting
Archery and bowhunting involve either
using the prosthesis for drawing the
string and releasing the arrow or holding and stabilizing the bow. Hand and
eye dominance affect how the prosthesis
is used. Some individuals can master
Figure 15
Grand Slam terminal devices used in swinging a bat. (Reproduced with permission from TRS, Boulder, CO.)
shooting a bow with the nondominant
eye, whereas others cannot. A patient
missing a left hand who has right-eye
dominance can shoot right-handed using the prosthesis to hold the bow. An
individual missing a left hand who has
left-eye dominance must shoot with
the right hand or switch to a left-handed bow and draw the string with the
prosthesis. Alternatively, an individual with a right hand absence and right
eye dominance can shoot right-handed
and draw the bow with the prosthesis
or must shoot left-handed while holding
the bow with the prosthesis and using
the nondominant eye. A voluntary-closing prehensile device (Fig ure 10) has
the physical configuration to capture the
riser handle of almost any bow, and a
simple lock pin or other more complex
locking system can be used to eliminate the need for conscious, continuous,
prosthetic cable tension while shooting.
In most instances, padding the handle
with a durable, compressive material
helps create a better gripping platform
for more accurate bow control and improved arrow flight. A tight or rigid grip
Photographs (from left) of the Pinch Hitter, Pinch Hitter HD, Pinch Hitter Flex, and
on the bow is counterproductive to accurately shooting an arrow.
The Ishi Archery terminal device
(TRS) was designed for holding and
shooting a bow by either a left- or
right-handed user (Fig ure 16). It has a
special offset aperture-receiver that helps
the bow align properly in the prosthesis during the string-draw phase of the
shooting cycle. The Archery Quick Release Gripper (Texas Assistive Devices)
is specifically designed for capturing,
drawing, and releasing the bowstring
(Fig u re 17). The Gripper uses an integrated trigger that is actuated by pressing
a side-mounted lever against the jaw or
cheek to release the string. The design
is consistent with established, reliable
trigger releases widely used in the sport
by two-handed archers and bow hunters.
The disadvantage of any prosthetic
device designed to meet the needs of a
specific activity is that it limits the user’s
ability to perform other activities that
require two-handed competence. If this
is an important consideration, such as in
bowhunting, a more versatile terminal
device might be preferable.
Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
370
Chapter 30: Upper Limb Adaptive Prostheses for Vocation and Recreation
Figure 16
terminal device f or holding and shootin g a bow.
(Reproduced with permission from TRS, Boulder, CO.)
Photograph of th e ISHI Archery
In archery, an externally powered
myoelectric hand prosthesis can be
used. The opposed thumb and forefinger
gripping configuration of a myoelectric
hand prosthesis lends itself to holding
a bow in a natural manner.
Fishing
Fishing, like golf, has nuances related
to hand dominance and hand absence.
Certain reel-and-rod fishing systems are
designed to function with either a lefthand or right-hand retrieve. Some types
of reels can be converted to a right-hand
or left-hand retrieve. The prosthesis can
be used for the function of reeling with
a normal reel handle if the terminal device is capable of creating enough controlled prehension (grip) throughout
the reeling cycle. Split-hook prostheses
that are held closed by elastic bands
or springs typically are not capable of
reliably controlling and operating the
reel handle because they tend to pry or
slip off. A voluntary-closing prehensile
device enables the user to create enough
gripping force to control reel handles of
various shapes and sizes (Figure 18). In
some instances, it may be valuable to reshape the reel handle or pad the handle
with compressible, high-friction material to create a better surface for securely
grasping and controlling the handle.
Holding the rod in the sound hand
and reeling with the prosthesis is the
most functional and versatile way to fish
because handling the rod properly is
Figure 17
from Texas Assistive Devices, Brazoria, TX.)
Figure 18
produced with permission from TRS, Boulder, CO.)
Photograph of the Archery Quick Release Gripper. (Reproduced with permission
Photograph of the Grip 3 prehensile device being used with a spinning reel. (Re-
enhanced by having a functional wrist
and hand. Specialized prosthetic reeling adaptations, such as the All Purpose
Crank Adaptor (Texas Assistive Devices;
Fig ure 19), are an alternative to using a
standard terminal gripping device.
If the user prefers to hold the rod
with the prosthesis, a device such as the
F~ISHI (TRS) can be used to grasp and
clamp around the fishing rod handle
(Figure 20). The flexible polymer body
simulates radioulnar wrist action when
the rod and line are under load, creating
a “feeling” and type of feedback similar
to that experienced with a normal wrist.
Other models are available for different
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
371
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