Upper-Extremity Prosthetics - The Iraqi Experience

David Baty, CPO, LPO
Dynamic Orthotics & Prosthetics
Houston, Texas

Suzanne Krenek, MOT, OTR, ATP
The Institute for Rehabilitation and Research (TIRR)
Houston, Texas

Phil Stevens, CO, LO
Dynamic Orthotics & Prosthetics
Houston, Texas

Shawn Swanson, OTR/L
Otto Bock Health Care
Minneapolis, MN

Secondary to accusations and charges of handling US Dollars, seven businessmen from Iraq had their right hands amputated and crosses tattooed on their foreheads by Saddam Hussein in 1995. During the nine years, which followed, many of their fellow countrymen saw them as thieves as a result of their missing hands and tattooed foreheads. Additionally, the gentlemen described feelings of shame, as they could not present their right "clean" hand to eat or shake hands. These seven gentlemen with right wrist disarticulation limb loss were brought to Houston, Texas in April/May 2004 for the purpose of obtaining new right hands. The gentlemen received donated services ranging from revision surgeries, myoelectric prosthetic componentry, fitting and fabrication of definitive prostheses and occupational therapy. The gentlemen's progress is chronicled from start to finish, which includes: revision surgeries, pre-prosthetic occupational therapy, fitting and fabrication of their temporary prostheses, initial prosthetic training, the delivery of their definitive prostheses and the conclusion of their occupational therapy training with the finalized prosthesis.

Several months after the Iraqi gentlemen returned to their homes, the team members met to review the experience. For the sake of simplicity, the process was initially broken down into pre-prosthetic and post-prosthetic strategies as it related to the key team members: the surgeons, the prosthetists, the occupational therapists, and the manufacturer's representative. Upon further break down of the process the following noteworthy items emerged: 1) clinical reasoning, helping others understand the component selection process, 2) "interesting observations" regarding the training process, language barriers, and cultural issues, 3) initial, interim and continuous challenges which were encountered throughout the process, and finally 4) the important follow-up concerns of what happens once the gentlemen return to their homes overseas.

The abundance of care these individuals received in a relatively short treatment window was in large part do to the close collaboration which evolved between the clinical prosthetists, treating occupational therapists and the manufacturer's representative. The efficiencies gained in having each discipline represented throughout the process of rehabilitation are discussed and highlighted during the presentation.

This collaborative effort also helped analyze those insights gained in having such a unique situation of seven subjects with similar amputations, amputation dates, prosthetic componentry, and training. The clinical team involved attempted to discern what attributes seemed to correlate with better acceptance and mastery of the prosthetic devices, and which attributes appeared to hinder prosthetic rehabilitation. Certain attributes, which seem intuitively relevant to the success of prosthetic rehabilitation, were found to have had no appreciable bearing on early acceptance and functional mastery of the prosthetic devices.

Secondary to the uniqueness of this situation, the team concluded that further analysis might also help define 1) potential influencers on prosthetic wear, acceptance, and mastery, such as perceived motivation, socket comfort, language barriers, and pain, and their impact on both the "immediate" outcomes, which took place in Houston, and "follow-up" outcomes, which took place after returning to their respective homes. The "follow-up" outcomes were ascertained by phone/email interviews in January/February 2005 and will be discussed during the presentation.