Most of the conditions also cause progressive weakness of the shoulder girdle muscles, however, deterioration in the muscles of the forearm and hand is slower.
Once a certain level of shoulder weakness is reached, the weight of the arm cannot be supported and active use of the shoulder is lost.
At this stage, if the elbow is supported, movement of the forearm and hand can still be utilised. People may develop alternative methods of movement such as bringing the head to the hand, using one arm to support the other or “creeping” the fingers along a hard surface.
Such compensatory methods cause the development of abnormal postures and allow only limited functional use of the arm. Loss of the use of the arms is one of the most frustrating and debilitating aspects of these neuromuscular conditions.
Duchenne is the most common type of muscular dystrophy; it causes rapid progressive muscle weakness in children. They usually lose the ability to walk between the ages of 8 and 11 years.
The weakness continues to progress, finally resulting in the inability to use the arms during the teenage years. These children are then completely dependent upon others for all activities of personal care, movement and often, feeding.
The Equipment
The Neater Arm Support is the only powered height adjustable arm support available on the market. It supports the user’s forearm in a sling and enables the arm to be raised and lowered. It provides frictionless, gravity-eliminated movement at a range of heights.
Other arm supports are available but their effectiveness is limited as they only operate on a single horizontal plane. Whilst they may enable people with weak shoulders but reasonable hand function, to type or to use a computer, they do not permit any significant vertical movement.
The design and geometry of the Neater Arm Support gives the user a very wide reach, increasing the range of tasks it can be used for compared with a standard arm support. It is usually attached to the back of the user’s powered wheelchair (although can be fitted to a free-standing base if this is more appropriate) and is operated using a simple switch.
Supplier’s details
The Neater Arm Support is available from Neater Solutions Ltd
12 Burlington Road, Buxton, Derbyshire SK17 9AL
Tel: 01298 23882 Fax: 01298 23883
Email: info@neater.co.uk
web: www.neater.co.uk
The price of the arm support includes a demonstration of the equipment, delivery and set up and a three year guarantee. No servicing is needed. (The Neater Arm Support can be removed from a wheelchair if it is no longer needed and re-used. There would be a charge for re-fitting to another wheelchair as it is likely that new bracket would be required).
Benefits
Physical
- The user can independently take the arm through a range of movement which they would not normally be able to manage, so helping to reduce the development of joint contractures
- The user can perform gentle active assisted movements of the arm which will help to maintain muscle strength
- The use of normal movement patterns helps reduce the development of postural deformities
Psychological
- Losing the use of one’s arms is obviously extremely disabling. Being dependent upon carers for feeding, all personal care activities and even the simplest of tasks (eg scratching ones face or rubbing an eye) can be very demoralising.
- Restoring or maintaining independence in these areas is likely to have an extremely beneficial effect on psychological well-being.
Social
- The user is able to carry out many self-care activities independently - such as washing, cleaning teeth, wiping nose, scratching face, re-positioning glasses
- The support will assist the user with feeding and drinking
- Allows access to leisure pursuits, eg painting, embroidery
- Independent use of lifts/road crossings (user can reach the controls)
- Reduced dependence on carers - people with very limited arm function are obviously going to need assistance with all tasks. This can be a heavy burden upon parents/partners or paid carers and can mean that the disabled person cannot be left alone, even for short periods.
- Provision of the arm support will reduce the input needed from carers and may enable users to be left for short periods.
Education/Employment
- The support can help with accessing a computer keyboard
- Able to answer phone, lift handset to ear
- Improved ability to reach textbooks, files and folders, turn pages etc
- Children will be able to raise their hand (to a certain extent) in class
- Improved access to controls eg. lifts, equipment
- Enables user to shake hands
Provision/Funding
The above list is not comprehensive but gives an idea of the benefits of the Neater Arm Support to clients with severe limitation of use of the upper limbs. There is obviously considerable cross-over between the above benefits and therefore it may be appropriate that the equipment is provided through joint funding.
Although initially, it was expected that most users would have a single Neater Arm Support, to improve function, assessment has shown that there are considerable benefits to being able to use the support with both arms.
The company can now make a modification to the equipment to enable it to be used with both arms (at different times). Although it is more expensive, provision of the modified version would be recommended in many cases. However, a full assessment of the equipment is essential.
There is routine provision of wheelchairs for people who are unable to walk and routine provision of replacement limbs for amputees. The Muscular Dystrophy Campaign would like to see routine provision of powered height-adjustable arm supports for those with severe loss of arm function.