Prosthetic Workshop Manager, Roy Franks, spoke about the initial brief saying, "Damien informed me that the patient had no muscle in his upper arm, but unlike with the prosthetic sockets I usually produce, he still had a limb to accommodate. He had an idea of what he wanted to achieve and how the device would need to function. But to bring it to life, orthotic and prosthetic techniques needed to work alongside each other. So the question was - how do we solve this and how do we help the patient use his arm and give him some sort of control again?"
"A lot of it was to do with the positioning. We came up with a bivalve polypropylene shoulder socket that mimics the shape of the missing muscle tone. The inside is built up with soft padding for comfort and to help contain and pressurise the muscle for hydrostatic control, allowing for increased movement of the arm as he contracts his bicep and tricep. We spent a bit of time just taping it on him rather than bolting it in place because we didn't want to put loads of holes in it and then find out they were in the wrong place. And while the position of the straps didn't change, we altered the lengths a few times to get the tension exactly right to help reduce medial rotation of the shoulder." said Roy.
Damien added, "The forearm cuff is made out of leather because it's breathable and shapes to the skin well. The hinge is quite complicated in the fact that there are two, both on the inside and the outside that contain the arm in between to get support through the shoulder and through the forearm. As the forearm is fully functional and heavy, without the hinges and forearm cuff, it would cause the residual soft tissues to elongate and twist due to the lack of skeletal framework in-between the fore and upper arms."
The final piece of the puzzle was the joint. Presented with this challenge was Metalwork Team Leader, Ash Smithson. He said, "I'd never had to manufacture anything like this in my time at Steeper, a conventional joint would not have been suitable for this patient's requirements. Homing in on the expertise of my team, we worked together and came up with three potential joint designs that we continued to adjust to enhance the joint function. We were very happy with the finished brace as it looked good and had great functionality!"
Regaining Independence After Bone Cancer
The finished Made-to-Measure ortho-prosthesis that Mr James wears today is a result of numerous trial and error processes. From improving the design of weak joints to perfecting the position and shape of each cuff, his Steeper team stopped at nothing to make sure the device was functional and comfortable. With Damien even going as far to carry out multiple home visits to keep Mr James comfy and save money for the hospital trust. The device allows Mr James to use his arm, elbow, hand, and fingers, to carry out his everyday activities while also providing critical support by encapsulating the residual soft tissues to prevent them from elongating, which could potentially cause injury where the exposed bones remain.
It's been a long road for Mr James, and a recent kidney cancer diagnosis and lower limb weakness has decreased his mobility significantly, however, he remains resilient in the face of adversity and has dreams of documenting his experience with Bone Cancer in a book. He says,
"I just want to keep going. I've had to keep going all my life, from day one, I was born during an air raid. I'm not going to stop now!"
Download Mr James' Story