inMotion Magazine

Finding Answers 31 collaboration between therapists and a whole care team, especially prosthetists, is key. The care process is already burdened with insurance coverage hoops, acute attention to wound healing and preventing overuse in sound limbs. “My prosthetists are great, so I work really closely with them,” Klarich says. “I have two or three prosthetists in the area that can come directly to the therapist office and either come during a therapy session or I can communicate with them and they can go to their office to have something changed or fixed.” Settings like Klarich’s, however, are rare. In the U.S., coordinated systems for care are limited and complex. Klarich says billing and state licensures can be barriers to practitioners working together. Geography can also isolate therapists and patients from teaching hospitals, trauma centers and specialized rehabilitation resources. Gender, age, socioeconomic position, race and education also contribute to disparities. Finding answers to holistic rehabilitation may necessitate a relational approach. That’s where handsmart comes in: to make sense of these variants and provide a live network of support for clinicians and their patients. Working on a voluntary basis, group members are gradually adding content to the Web site according to a standard of easily understandable evidence-based research. Current resources include comparisons of body-powered and myoelectric prostheses, information about mirror therapy for phantom limb pain and recommendations for finding prostheses manufacturers. The group members themselves have already benefited from the connection, learning about the differences between people’s care requirements, reimbursement systems, prosthesis fitting standards and levels of practitioner knowledge in various nations. There’s one universal message that Liselotte Hermansson, an occupational therapist and professor of health sciences in Örebro, Sweden, would like all physicians to know: Patients are all individuals, and a prosthetic hand can never fully replace a lost hand. Ramdial encourages clinicians to work with clients and their families, helping them remain active members of their communities and, together, achieve great outcomes. “One of the tasks of the handsmart group has been to determine best practices for how to treat children and adults with upper‑limb loss or limb absence, and we are compiling information toward that goal,” says Birgit Bischof, a founding member of handsmart and clinical rehabilitation specialist for OttoBock HealthCare in Austria. International efforts such as these could address challenges in prosthetics research to find sample sizes large enough for generalizable conclusions. handsmart’s first survey was related to treatment for children and was created to capture differences in various parts of the world. The results are now being finalized and will be posted to the site in the near future. The handsmart group is a nonprofit organization of healthcare professionals, formed to guide practitioners in areas where there are gaps in data regarding upper-limb loss. We collaborate, form smaller working groups and decide on our projects by being inclusive of others’ perspectives and have increased awareness by representing the work we’re doing nationally and internationally.