2018 International Occupational Therapy Conference 2018 国际作业治疗研讨会 Simon s Ring : New splint design to enhance hand function training 锦环 : 增强手功能训练的支具新设

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1 2018 International Occupational Therapy Conference 2018 国际作业治疗研讨会 Simon s Ring : New splint design to enhance hand function training 锦环 : 增强手功能训练的支具新设计 Simon Kam Man Wong Occupational Therapy Department, Tai Po Hospital 黄锦文香港大埔医院

2 Hand Function 手功能 The readiness to pick up, hold, manipulate and release objects. 拿起握稳控制放开 Terminal pinch Directional grip Power grasp Opposition pinch Hook grip Span grasp Key pinch Biomechanics of the Hand Duncan, Saracevicb, & Kakinoki Hand Clin 29 (2013)

3 Most activities require the use of the thumb in opposition and the metacarpal-phanlangeal (MCP) joints in an appropriate position. 大部分活动需要拇指能对指及掌指关节在适当置

4 临床常见的影响手功能的情况 Clinical condition that Affect Hand Function 高位截瘫臂丛损伤正中神经损伤 (Tetraplegia, Brachial Plexus, Median Nerve Palsy) 类风湿性关节炎 (Rheumatoid Arthritis) 偏瘫 (Hemiplegia)

5 高位截瘫手支具的设计 Splint Design for Tetraplegic Hand Tenodesis action train wrist extension 训练腕背伸力度及利用屈肌腱长度增加握力

6 高位截瘫手支具的设计 Splint Design for Tetraplegic Hand

7 正中神经损伤手支具的设计 Splint Design for Median Nerve Palsy

8 正中神经及尺神圣损伤支具的设计 Splint Design for Median & Ulnar Nerve Palsy

9 类风湿性关节炎手支具的设计 Splint Design for Rheumatoid Arthritis

10 类风湿性关节炎手支具的设计 Splint Design for Rheumatoid Arthritis Prevent Ulnar deviation at MCPJ 防止掌指关节尺偏

11 新设计关节要求对掌掌指关节约设计要求比以前设计简单较易制造 New Design Joint Requirement Opposition MCPJ arount Design Requirement Simplier than previous design Easy to make

12 新设计设计理念利用拇指与其它手指近节的距离和关系 New Design Key concept of design The relation position of the proximal phalanx of the thumb and other fingers Simon s Ring Simon s Ring 锦环

13 锦环的优点 Advantages of the Simon s Ring u Easy to make u Fabrication time just about 10 minutes u No need to involve the wrist joint u Easy to put on u 容易制作 u 制作时间约 10 分钟 u 不需要通过腕关节 u 容易穿戴

14 新设计用於高位折瘫患者 New Design applied in Tetraplegic hand

15 新设计用於高位折瘫患者 New Design applied in Tetraplegic hand

16 新设计用於高位折瘫患者 New Design applied in Tetraplegic hand

17 新设计用於高位折瘫患者 New Design applied in Tetraplegic hand

18 新设计用於类风湿性关节炎患者 New Design applied in Rheumatoid Arthritic hand

19 新设计用於类风湿性关节炎患者 New Design applied in Rheumatoid Arthritic hand

20 偏瘫痉挛上肢支具设计 Splint Design for Spastic Hemiplegic Hand 手背面设计 (Dorsal approach) 手掌面设计 (Volar approach) 抗痉挛支架 (Anti-spasticity splint)

21 偏瘫痉挛上肢支具设计 Splint Design for Spastic Hemiplegic Hand 抗痉挛支架前臂放在旋後位掌背方式前臂放在中旋位 (Anti-spasticity splint)

22 Traditional Splint Design for Spastic Hemiplegic Hand (Dorsal approach) (Volar approach) Anti-spasticity splint

23 以往上肢抗痉挛支架的设计 Characteristics of Previous Design 静态支具, 很少能配合手功能训练 (Static splint, not for hand function training) 很难在痉挛较强的患者手上塑型 (Difficult to mold directly in patient s hand) 不能配合患者的进步来修改 (Difficult to make adjustment according to progress of patient)

Can change component to different wrist extension

24 上肢抗痉挛支架新设计 New Design for Anti-spasticity Splint 3rd Generation 第三代 Simon s Ring 锦环可换不同手腕背伸幅度的配件 Can change component to different wrist extension 手背面设计在穿戴支具时间可运用摃扞原理 Easy to apply with dorsal approach

25 上肢抗痉挛支架新设计 New Design for Anti-spasticity Splint

26 上肢抗痉挛支架新设计 New Design for Anti-spasticity Splint 可使用不同角度的鋼絲控制虎口的幅度, 使患者能主動或被動地參與手功能訓練 Spring coil to provide different size of 1 st web

27 上肢抗痉挛支架新设计 New Design for Anti-spasticity Splint 除去鋼絲, 換上拇指及手指部分, 可作為晚上休息支具 Change to a night splint to keep finger extension

28 上肢抗痉挛支架的制作 (Fabrication)

29 上肢抗痉挛支架的制作 (Fabrication)

30 上肢抗痉挛支架的制作 (Fabrication)

31 上肢抗痉挛支架新设计的特色 Characteristics of the New Design 较易在患者手上塑型 (easy to wear) 可把拇指放於对指位置, 使患者可主动或被动地叁与手功能训练 (Position hand in opposition, patient can participate actively or passively in functional activities)

32 上肢抗痉挛支架新设计的特色 Characteristics of the New Design 设计可调较虎囗的宽度, 方面拿不同大小的物件 (New design allows easy change of spring coil to adjust the size of first web when patient use hand in functional activities) 可转换手腕背伸角度部分 (Easy change of wrist component if patient shows improvement) 晚上可加上手指部分, 保持指间关节伸直 (Easily adding component to keep finger in extension at night time)

33 Use of Multi-rings for Stroke Hand 偏瘫患者多环式设计

34 感觉刺激在偏瘫患者运动康复

35 Splint changes the Mode of Hand Function Training 支具改变手功能训练的形式传统方式 Traditional Approach New Approach with Splint 用支具后的方式 Early participation in grasping More stimulation to the brain 早期患手参与握放活动对脑部的刺激

36 Innovation 创新

37 Innovation by Changing the Connection Design 改变连接部分的设计钢丝 Wire 不影响掌指关节的活动 Do not limit MCPJ motion Bar 柄 U-Shape U 型 Allow insertion of aids 可加上辅具

38 Innovation by Changing the Material 改变材料的设计使用橡皮筋 Same pattern but using elastics band Thermoplastics 低温塑料 Turn Finger Ring to adjust position of the thumb Add small rigid bar into connection pocket to act as blocker for mobilization of PIPJ or DIPJ u 转动手指环来控制拇指位置 u 加小板块帮助训练指间关节的活动

39 Innovation by Changing the Ring Design 改变环的设计 5 Rings 5 环 2 Rings 2 环 For Median & Ulnar Nerve Palsy 正中及尺神经损伤 Contract Extensors Relax Extensors 收缩或放松伸肌

40 Innovation by Changing the Connections 改变连接部分的材料用弹簧连接 Connect with spring 锻炼指伸肌 Training of extensors Connect at lateral side 连接指环侧面锻炼指间肌 Training of Interossei

41 Innovation by Changing the Fabrication Method 改变制造的方法 Manual 人手制造 3D Printing 3D 打印

42 Innovation by Changing the Ring, Connection and Fabrication 改变指环连接及制作方式 Traditional Capener Splint 传统的 Capener 支具手指纽扣型变形的治疗 Treatment for Boutonneire Deformity Two 3D Printed Hinged Finger Rings by elastic band 使用橡皮筋及 2 个指环新设计

43 Innovation by Combining Splint and Aids Simon s Ring + Specially designed Aid 锦环 + 特别设计辅具支具与辅具的组合 Future development will be using 3D Printing for more Systematic and Stylistic Design 将来发展是使用 3D 打印有系统地制造个人化的设计

44 Conclusions 结语 Simon s Ring is a simple and effective design 锦环的设计简单及有效用 The fabrication time is only about 10 minutes 制作只需约 10 分钟 It could be applied in stroke patient to encourage early participation of the affected hand in active or passive grasping to enhance neuroplasticity 偏瘫患者早期使用患手主动或被动参与握放活动训练, 增加脑部重塑的效果

45 Conclusions 结语 Innovation by changing the material, connection and fabrication methods 改变材料连接及制造方法来创新 Splint + Aid + 3D Printing + Ring concept + Relationship between finger joints 支具 + 3D 打印 + 指环概念 + 指关节的关系 Systematic and Stylistic production 系统及个人化的设计及生产

46 Thank You 谢谢聆听

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