Are High-Tech Upper Limb Prostheses Always the Best Option?

ETDs and ETD2s, while they are myoelectric, are pretty robust options. They work great for someone looking for a relatively heavy-duty option that also provides fluid movement based on generating muscle signals to electronically open and close the ETD, instead of body-powered hooks that require a harness and shoulder movement to open and close. ETDs are very strong, able to grip and pinch similar to that of a sound hand. A downside for all types of myoelectric devices is they need to be plugged in at the end of each day to recharge, they are typically heavier in weight than their non-electric counterparts — caution must be taken when using them in dirty, dusty or wet environments, and they can sometimes require more maintenance.

Low-tech options can be helpful in many situations. Our patients have had success using them to: to weld, farm, work on cars, garden, perform chef duties, work at their construction job ... well, the list goes on and on. Body-powered hooks, body-powered finger devices, passive positional fingers — all of these options work great for people who need to do work and home projects that could potentially harm a myoelectric device. Body-powered options generally require less maintenance, they are durable and restore the ability to grasp and pinch. There are also some disadvantages to consider: they do not restore the same amount of grasp and pinch force as most myoelectric options, and some body-powered devices can lead to overuse issues, especially when good body ergonomics are not used.

Circling back to custom passive silicone restorations, these items can do wonders for people who would like to “fit in.” In addition to looking like a “real” limb, finger or partial hand, these items can offer both length (which can help with grasping objects) and protecting sensitive residual limbs. We had a patient who first asked for a custom silicone restoration because they didn’t want people to notice their missing finger. Later, they asked for a body-powered device (in purple!) because it provided more function. Another patient, Abram, pictured below, wanted only the most heavy-duty options: a body-powered hook and a TASKA multi-articulating hand. But after a few months of being stopped constantly by people who wanted to speak to him about how cool his prosthesis was, he decided to get a custom silicone restoration so he could walk through the airport without comment.