Marlies Cabell, CPO AOPA Case Report
TITLE: Case Report on the use of Bilateral Myoelectric Elbow-Wrist-Hand Orthoses for the Remediation of Upper Extremity Paresis following a Spinal Cord Injury
DISCLOSURE: No monetary funding was provided for this case study. The physician author has no affiliation with the company. The treating orthotist has no affiliation with the company.
CONTACT INFORMATION: Principle Orthotist: Marlies Beerli Cabell, CPO Ability Prosthetics and Orthotics, York PA Office: 717 851 0156 Email: email@example.com
Prescribing Physician: Philippinea Cabahug, M.D.
Myomo Contact: Samuel Kesner, PHD, Dir. of Research and Advanced Development, Myomo, Inc. One Broadway, 14th Floor Cambridge, MA 02142 Email: firstname.lastname@example.org
SUMMARY: This case report will describe, present, and discuss the experiences of a user who was fit with bilateral MEWHOs following a spinal cord injury sustained in July 2008 during a gymnastics accident. The user is a 28-year-old male, diagnosed with quadriplegia (SCI C4-C5). Upon initial evaluation he presented with paralysis, weakness and spasticity in both upper extremities. He uses a power wheelchair for mobility and requires caregiver assistance for all ADLs (activities of daily living). This user was fit with bilateral MEWHOs in December 2014 following a referral by his physician and Occupational Therapist to a certified prosthetist-orthotist (CPO). An evaluation was completed to determine his candidacy and then the orthoses were custom fabricated based on casts and measurements of his UEs. Once he received the MEWHOs, the user worked with an Occupational Therapist (OT) to complete a functional training program designed to maximize proficiency and functional outcomes.
RESULTS: Before starting with his bilateral MEWHOs, the user presented with significant upper extremity impairments and loss of function: no active range of motion (ROM) in BUEs, full passive range of motion (PROM) and moderate spasticity. Resting posture in his wheelchair was with elbows flexed, forearms supinated and wrists, MCPs and fingers flexed. The user is non ambulatory and relies on a power wheelchair for mobility. He uses a mouthstick to access his computer and cell phone and requires assistance for all ADLs including dressing, feeding, bathing and grooming. The user’s long term goals
with the MEWHOs include self-feeding with utensils, brushing his teeth, scratching his face and accessing/using his phone with his UEs instead of a mouthstick.The user underwent a functional training program with an Occupational Therapist to help maximize his proficiency and use of the MEWHOs. Therapy focused on caregiver training, how to care for and operate the MEWHOs, establishment of a home activity program, and facilitation of goal oriented and meaningful functional tasks.
At a follow up session with his Orthotist in March 2016, the user demonstrated 0 – 105 degrees of active elbow flexion (without the MEWHOs) in his LUE. He continues to be seen by an Occupational Therapist every 2-3 months for 1-2 weeks at a time, where they continue to address functional goals, upper extremity strengthening and tone management. The user is currently able to complete self-feeding tasks using his MEWHOs and adaptive feeding utensils. He is also able to complete self-grooming tasks including brush his teeth and comb his hair using his device. One of the more remarkable results of the user’s continued use of the MEWHOs is his ability to extend his arm in order to push automatic door openers and operate light switches without the assistance of the device. This improvement exceeds his objectives prior to being fit for the orthoses. He continues to use his bilateral MEWHOs 3-5 days a week for 30 minute sessions at home and to complete functional tasks throughout the day. In addition to these significant functional gains, the user reports that the MEWHOs have helped him mentally and emotional – helping him to stay motivated and to keep a positive outlook on life.