What gadgets can be used to assist a patient with compromised wrist motor function but preserved finger function and pinching ability?

Assistive Devices for Patients with Wrist Motor Impairment and Preserved Finger Function

For patients with compromised wrist motor function but preserved finger function and pinching ability, wrist-driven orthoses (tenodesis splints) are the primary assistive device, allowing the patient to leverage their intact wrist extension to passively close fingers for functional grasping. 1, 2

Primary Assistive Device: Wrist-Driven Orthosis

A wrist-driven orthosis (also called a tenodesis splint) is the standard assistive device for this specific presentation. 1, 2

• The device uses the patient's preserved wrist extension movement to mechanically drive finger flexion and thumb opposition for grasping 2
• This leverages the natural tenodesis effect where wrist extension passively closes the fingers 2
• The orthosis amplifies the patient's existing grasp force and provides additional mechanical support 2
• Modern versions with robotically adjustable kinematics allow users to adapt wrist posture across different tasks, reducing perceived exertion and improving versatility 2

Device Selection Criteria

Choose devices that allow free wrist mobility and adaptable positioning rather than fixed constraints. 2

• Devices with adjustable wrist kinematics enable users to select comfortable and natural postures depending on task requirements 2
• More wrist mobility freedom improves ease of use across different hand poses in the arm's workspace 2
• Avoid devices that impose rigid wrist constraints, as these generate undesirable reach and grasp kinematics and contribute to device abandonment 2

Adaptive Equipment for Activities of Daily Living

Provide task-specific adaptive devices with built-up handles to compensate for reduced grip strength. 1

• Eating utensils with built-up handles reduce the grip force required for manipulation 1
• Rocker knives eliminate the need for wrist rotation during cutting 1
• Long-handled sponges for bathing extend reach without requiring full wrist flexion 1
• Handheld showers provide better control than fixed showerheads 1

Advanced Technology Options

Wearable robotic exoskeletons can provide powered assistance for wrist extension during functional activities. 3

• The eWrist-type devices are one degree-of-freedom powered exoskeletons that support wrist extension training 3
• These devices use surface electromyography (sEMG) to detect weak muscle activation and provide assist-as-needed support 3
• They enhance activity of wrist extensor muscles during daily life activities while allowing the patient to maintain motor control 3
• This technology is particularly useful when patients can produce muscle activation but cannot generate overt movements 3

Critical Implementation Principles

Do NOT use static splinting or immobilization devices, as these prevent restoration of normal movement and promote learned non-use. 4, 5

• Static splints that hold the wrist in fixed positions are contraindicated for patients with motor recovery potential 4, 5
• Avoid prolonged positioning of the wrist at end ranges, which exacerbates symptoms and impedes recovery 4, 5
• The goal is to facilitate function while maintaining active motor practice, not to replace movement 4

Device Prescription Process

Prescribe assistive devices based on immediate functional needs while recognizing that many patients will not require long-term use as motor recovery progresses. 1

• Patients often use adaptive devices early during rehabilitation but discontinue them as function improves 1
• Consider the patient's specific environment and daily activities when selecting devices 1
• Training in proper device use is essential for maximizing functional benefit 1
• Ambulatory patients felt their walking confidence and safety improved with assistive devices and preferred using them rather than delaying mobility to achieve normal movement patterns 1

Complementary Rehabilitation Technology

Virtual reality gaming systems with handheld controllers (Wii) or motion capture systems (Xbox Kinect) can increase engagement and movement practice. 1

• These systems provide additional opportunities for repetitive wrist and hand movement practice 1
• They can be used as remotely monitored telerehabilitation systems for home-based practice 1
• Gaming technology increases participant engagement while providing functional task practice 1

Common Pitfall to Avoid

The most common error is prescribing devices that restrict wrist movement rather than facilitating it. 4, 2

• Devices that immobilize the wrist prevent the neural reorganization necessary for motor recovery 4
• Fixed-position orthoses eliminate the patient's ability to adapt wrist posture to different functional tasks 2
• This restriction increases task difficulty and contributes to device abandonment in long-term use 2