Making Freehand their hand: the role of occupational therapy in implementing FES in tetraplegia

For persons with tetraplegia, improvements in function and independence are promoted by augmenting residual hand function. Assistive technology offers ways to enhance independence through enabling activities of daily living (ADL) performance. Splints and adaptive aids have traditionally been used to address functional hand deficits in persons with tetraplegia secondary to spinal injury. The Freehand System©R offers a brace free alternative for persons with C5 or C6 tetraplegia. By employing functional electrical stimulation (FES), The Freehand System©R provides stimulated grasp and release to paralyzed muscles of the hand. Occupational therapy plays an important role in assessment and implementation of the Freehand System. Clinical reasoning is used to develop a comprehensive plan for surgical planning, rehabilitation and functional training to meet individual needs. Training incorporates education on operation and care of the system and functional application toward valued ADL. Research with the Freehand system is ongoing. Clinical trials of the Freehand system with both adult and adolescent subjects have demonstrated measurable improvement in pinch force, hand function and level of independence in ADL [9,12]. Current focus of research by occupational therapists with the Freehand system has been the examination of home use and user satisfaction.