Bionic hand becoming more acceptable in workers' comp system

An injured worker in Florida will be the beneficiary of new technology that is increasingly being seen in the workers' comp arena. The ruling should put employers and insurers on notice that they may soon see claims for the i-LIMB.

With costs approximately $15,000 more than the price of more commonly used hand prosthetics, employers and workers' comp insurers are not readily willing to foot the bill for the i-LIMB. But representatives for the developer say the device offers hand amputees more dexterity and thus the ability to return to their jobs more easily and effectively than they could with traditional devices.

"We have over 1,500 hands that have been provided in the U.S., and probably 30 to 40 percent have gone to workers' comp patients," said Mark Ford, vice president of global sales and marketing for Touch Bionics Inc. "It's become a significant number. It's more expensive, but the functional results for patients are dramatically beyond what previous upper limb prosthetic technology could do for patients."

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But Ford says the company has had to address the reluctance of employers and insurers. "Any time it's more expensive, any insurance payer wants to understand what it is they are paying for," he said. "It's brand-new technology, and we've had to overcome the view that it's experimental. Well, it's not and has proven what it can do."

What makes the device unique is its ability to allow the user to perform movements previously impossible: typing, for example.

The mechanics. The i-LIMB is controlled by a system that uses a traditional two-input myoelectric, or muscle signal, to open and close the device's fingers. It goes further than traditional hand prosthesis by placing a small motor in each of the digits, meaning that each finger is powered individually.

"The former technology had one motor and the ability [for the hand] to only pinch things; the thumb did not move, there was one speed, it was a very limited device," Ford said. "We now have a device that has far more capability -- five motors." The company is also using the technology for patients with partial hand amputations.

A prosthetist makes the socket into which the device will attach on the patient. Each one is customized for the patient.

"It's a highly programmable system," Ford said. "Using our unique software, the prosthetist and therapist have the ability to program the hand for the individual's needs. That comes into play in a big way when you talk about workers' comp patients."

Ford says it's imperative that in addition to the device itself, the patient gets proper occupational therapy. Typically, eight to 12 half-hour sessions are appropriate.

"A lot of times it gets overlooked," Ford said. "But as technology advances, it becomes more important that the patient learns how to use the device."

The occupational therapy protocol for an i-LIMB user should be heavily focused on the patient's activities of daily living, both vocational and avocational. Ford says the therapist should start with the basics then customize the therapy.

"If a person wants to go back to work in a warehouse setting, what is he going to need to do to [be able to] drive a forklift?" Ford said. Or the therapy can be structured so the user can "type all day long."

Screening candidates. While the company boasts a high success rate for the i-LIMB, it is not appropriate for everyone. For example, the amputee must have the cognitive capability to be trained on using the device.

"Some people don't have that," Ford said. "Sometimes there are people for whom it is not appropriate because they are not in a place mentally to use that technology."

Another requirement is that the patient has strong electromyography, or EMG signals emitting from the muscles of the remaining limb, since that is essential for the device's functioning. "If you can't find two strong myoelectric EMG sites, that person is probably not a great candidate," Ford said.

Cost factors. The cost of the device depends on a variety of factors, including the location of the amputation and the amount of work involved.

The process starts with Touch Bionics selling the i-LIMB to a prosthetist, who makes the socket and constructs an inner liner that protects the skin.

"Typically, for a below-elbow device being provided, that prosthetist's cost is probably going to be in the $45,000 to $55,000 range," Ford said. "It is more expensive, but it also allows the patient a whole new way of functioning in their daily lives."

The company also offers three-year extended warranties. Ford says with proper care, the i-LIMB should last four to five years.

Read more at the WorkersComp Forum homepage.

August 22, 2011

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