Open letter to Robohand DIYers
Important Safety Information for the Robohand
My name is Tyhanna Esham, OTR. I am an Occupational Therapist with twenty years of experience. For the past ten years I have specialized in hand therapy in Atlanta, Georgia.
Recently, I returned from Johannesburg South Africa where I studied Robohand design with its creator Mr. Richard Van As. Since his accident two years ago resulting in amputation of several digits, Mr. Van As (an amputee himself and having an intimate knowledge of the unique issues facing hand deficit individuals) has devoted much of his personal time, finances and knowledge toward developing cost effective, functional and safe uses for the Robohand design.
Regarding Construction of the Robohand:
- Use Robohand design #44150 (thingiverse) for durability. The “Snap Together” Robohand model (thingiverse # 92937) was intended for demonstration use only. It lacks strong, secure hardware and is prone to failure with heavy use.
- Use quality hardware as listed in the Assembly Manual. Lesser quality hardware may result in failure, rusting, poor cosmetics and most importantly a dysfunctional Robohand that could cause injury and infection. Stainless steel hardware with dome nuts must cover exposed screws to prevent injury to the wearer or others. Although stainless steel adds to the initial cost of a Robohand, it is stronger, safer and less likely to cause injury/infection making it more medically appropriate. Another benefit of stainless steel hardware is that it can be reused in upgrades as the child grows or as the Robohand is updated or replaced.
- Custom moulded Orthoplast is medically appropriate for Robohand use, provides an excellent surface for pressure distribution during use of the Robohand, thus decreasing the likelihood of pressure areas and injury. It is recommended that an experienced Occupational Therapist or Hand Therapist do the moulding. PLA plastic should not be used on bare skin. Although low cost and somewhat mouldable when heated, the PLA plastic’s pitted surface will collect sloughed skin cells, becoming an excellent breeding ground for bacteria. Its’ rough edges, pitted surface and inferior custom moulding characteristics make it likely to chaff the wearer causing skin lesions that may become infected. Medical Orthoplastic, when used by an experienced practitioner, is easily moulded, modified and cleaned. Use of zip ties, duct tape, and ill fitting, make shift items, like shin guards are likely to cause pressure areas. With continued use, these inappropriate items are likely to impair circulation, irritate fragile skin, sensitive scars, compress nerves and cause skin lesions.
Regarding Application/Use of the Robohand:
- Robohand should only be used by children/individuals with good skin integrity and intact sensation who possess the mental capacity to safely wear and properly use it. Children should be of an age to request and understand the purpose of the device.
- Wearers must inspect their skin regularly to ensure safety of fit. Any problems must be promptly addressed to prevent injury.
- Amputations, crush injuries, burns and multiple or recent surgeries often result in fragile skin, compromised circulation, sensitive scars, and painful neuromas. These issues can take years to resolve and may result in a life long struggle. This last scenario is made more likely if an ill fitting device is applied or any device is applied when inappropriate. Burn victims and individuals with hyper sensation or lacking sensation are generally not good candidates for Robohands.
- Please do not use children for R&D purposes as they are often unaware or unable to reliably report pain resulting from an ill fitting device.
- Consult with an Occupational Therapist or Hand Therapist to determine suitability and proper fitting.
Robohands are a tool that can enhance performance of certain tasks; they should not be presented as a panacea. We need to be mindful of not creating unrealistic expectations. Sometimes other devices or adaptations are more helpful.
While I admire and encourage exploration of 3D printing technology to expand ways to help people with limb deficiencies find functional, low cost, life enhancing devices, I recommend the use of consenting adults who will participate in follow-up during the R&D process.
I too am excited about the new Robohand technology, but I must emphasize caution and discretion with its use. Children, their parents, and adults with limb deficiencies may be experiencing physical and emotional difficulties that people with normal limbs cannot imagine.
Let us all tread lightly and first, Do No Harm.
Tyhanna Esham OTR/L Robohand USA
Lynda Poole, OTR Paediatric Occupational Therapist
Grae Scheuber BSc(Hons), Robohand Australia