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Manipulative appliances for quadriplegics
MANIPULATIVE OSCAR
E. BEDER,
APPLIANCES
FOR
QUADRIPLEGICS
B.S., D.D.S."
Seattle, Wash.
I
WHO HAVE SUSTAINED a major injury to the spinal cord in the cervical area may become quadriplegic. The sequela of the loss of the use of the extremities, specifically the hands and arms, indicates a rehabilitation procedure whereby compensatory functions by the head and neck are made possible by the use of auxiliary prostheses. Intra-extraoral devices fabricated for a patient to enable him to perform certain tangibly constructive procedures will boost his morale and motivation, and thus reduce vegetative existence tendencies. One appliance functions with the vertical excursive movement of the mandible causing its finger- or tong-like extensions to come together and grasp an object. Others are grasped between the teeth, and movements of the head and neck activate the effectuating portion of the appliance. NDIVIDUALS
DESIGN
Grasping Device (Fig. 1) .-The intraoral portion consists of a maxillary custom-made plastic splint or mouthpiece (Fig. 2), and a mandibular plastic sheet of adequate thickness (to prevent bending under biting force) (Fig. 3). The splint is rigidly attached to a plastic tube, while the mandibular portion, with an outline approximating that of the appropriate mandibular arch, is rigidly attached to a plastic rod that is of a gauge similar to the inner diameter of the tube. The rod fits into and is longer than the tube at both ends to permit attachment of the auxiliaries. The tube and rod must be of adequate length in order that the patient’s binocular vision is not affected. At the extraoral end of the tube and rod, plastic “claws” or “fingers,” fabricated from thermoplastic (for easy recontouring) toothbrush handles, for example, are rigidly attached. The exposed end of the rod permits attachment of one of the fingers. Both toothbrush handles are heated and reshaped in a manner to make them convex outward and so that the ends are in apposition. Adjacent to the open end of the tube, the rod has a circumferential addition of quick-cure plastic to act as a stop and thus maintain the relative position of the rod to the tube, which in *Professor and Director, Maxillofacial Prosthesis Clinic, University School, and Children’s Orthopedic Hospital and Medical Center. 785
of Washington
Dental
J. Pros. Den. July-Aug., 1964
Fig.
Fig. Fig. Fig.
Z.-The 3.-The
maxillary mandibular
Fig.
L-The
grasping
device.
2.
Fig. mouthpiece of the grasping device plate of the gasping device.
4.-The
fingers
and spring
of the grasping
device.
3.
Fig.
Fig.
6.
Fig. B.-The wand in the functioning Fig. 7.-A patient with the grasping
Fig.
S.-An
example
position. device in a functioning
of the grasping
device
position.
in action.
7.
788
BEDER
J. Pros. Den. July-Aug., 1964
turn will maintain the functioning relationship of the fingers to each other. A stainless steel spring wire of narrow gauge is so bent as to duplicate the action of a safety pin. Each free end of this wire is attached to a retentive area in each finger. The unattached ends of the latter have rubber tubing positioned on them in order to prevent slipping of the objects as they are picked up (Fig. 4). The wire keeps the fingers apart ; biting will bring them together. Wands.-A wand is attached to an auxiliary mouthpiece with a mandibular tooth index (centric occlusion) on its lower surface-one with a solid rod with a rubber tip that may be used with an electric typewriter and the other with a metal (aluminum) open-ended tube that will accommodate a ballpoint pen, paint brush, etc. (Figs. 5 and 6). CASEREPORT
T. M., a 20-year-old male, dove into shallow lake water and sustained a broken neck with concomitant paraplegia. The grasping appliance and wands described above were fabricated for him. The patient became quite proficient in the use of these appliances (Figs. 7 and 8). SUMMARY
Intra-extraoral appliances for patients, who, because of cervical neurologic injuries, have lost the use of their extremities, are described. These are designed to enable these patients to perform certain functions such as grasping, lifting, and moving objects. Thus the quadriplegic can write, paint, type, play checkers, etc. Incentive and morale are thereby increased. Modifications of these appliances may be prescribed for other handicapped persons, such as a patient after a stroke. UNIVERSITY OF WASHINGTON SCHOOL OF DENTISTRY SEATTLE, WASH. 98105
E. BEDER,
APPLIANCES
FOR
QUADRIPLEGICS
B.S., D.D.S."
Seattle, Wash.
I
WHO HAVE SUSTAINED a major injury to the spinal cord in the cervical area may become quadriplegic. The sequela of the loss of the use of the extremities, specifically the hands and arms, indicates a rehabilitation procedure whereby compensatory functions by the head and neck are made possible by the use of auxiliary prostheses. Intra-extraoral devices fabricated for a patient to enable him to perform certain tangibly constructive procedures will boost his morale and motivation, and thus reduce vegetative existence tendencies. One appliance functions with the vertical excursive movement of the mandible causing its finger- or tong-like extensions to come together and grasp an object. Others are grasped between the teeth, and movements of the head and neck activate the effectuating portion of the appliance. NDIVIDUALS
DESIGN
Grasping Device (Fig. 1) .-The intraoral portion consists of a maxillary custom-made plastic splint or mouthpiece (Fig. 2), and a mandibular plastic sheet of adequate thickness (to prevent bending under biting force) (Fig. 3). The splint is rigidly attached to a plastic tube, while the mandibular portion, with an outline approximating that of the appropriate mandibular arch, is rigidly attached to a plastic rod that is of a gauge similar to the inner diameter of the tube. The rod fits into and is longer than the tube at both ends to permit attachment of the auxiliaries. The tube and rod must be of adequate length in order that the patient’s binocular vision is not affected. At the extraoral end of the tube and rod, plastic “claws” or “fingers,” fabricated from thermoplastic (for easy recontouring) toothbrush handles, for example, are rigidly attached. The exposed end of the rod permits attachment of one of the fingers. Both toothbrush handles are heated and reshaped in a manner to make them convex outward and so that the ends are in apposition. Adjacent to the open end of the tube, the rod has a circumferential addition of quick-cure plastic to act as a stop and thus maintain the relative position of the rod to the tube, which in *Professor and Director, Maxillofacial Prosthesis Clinic, University School, and Children’s Orthopedic Hospital and Medical Center. 785
of Washington
Dental
J. Pros. Den. July-Aug., 1964
Fig.
Fig. Fig. Fig.
Z.-The 3.-The
maxillary mandibular
Fig.
L-The
grasping
device.
2.
Fig. mouthpiece of the grasping device plate of the gasping device.
4.-The
fingers
and spring
of the grasping
device.
3.
Fig.
Fig.
6.
Fig. B.-The wand in the functioning Fig. 7.-A patient with the grasping
Fig.
S.-An
example
position. device in a functioning
of the grasping
device
position.
in action.
7.
788
BEDER
J. Pros. Den. July-Aug., 1964
turn will maintain the functioning relationship of the fingers to each other. A stainless steel spring wire of narrow gauge is so bent as to duplicate the action of a safety pin. Each free end of this wire is attached to a retentive area in each finger. The unattached ends of the latter have rubber tubing positioned on them in order to prevent slipping of the objects as they are picked up (Fig. 4). The wire keeps the fingers apart ; biting will bring them together. Wands.-A wand is attached to an auxiliary mouthpiece with a mandibular tooth index (centric occlusion) on its lower surface-one with a solid rod with a rubber tip that may be used with an electric typewriter and the other with a metal (aluminum) open-ended tube that will accommodate a ballpoint pen, paint brush, etc. (Figs. 5 and 6). CASEREPORT
T. M., a 20-year-old male, dove into shallow lake water and sustained a broken neck with concomitant paraplegia. The grasping appliance and wands described above were fabricated for him. The patient became quite proficient in the use of these appliances (Figs. 7 and 8). SUMMARY
Intra-extraoral appliances for patients, who, because of cervical neurologic injuries, have lost the use of their extremities, are described. These are designed to enable these patients to perform certain functions such as grasping, lifting, and moving objects. Thus the quadriplegic can write, paint, type, play checkers, etc. Incentive and morale are thereby increased. Modifications of these appliances may be prescribed for other handicapped persons, such as a patient after a stroke. UNIVERSITY OF WASHINGTON SCHOOL OF DENTISTRY SEATTLE, WASH. 98105