Ethan Payton: Getting a Better Grip

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By Sherri Edge

Payton and Miguelez discuss the functional advantages of the Michelangelo Hand. Photographs courtesy of Advanced Arm Dynamics.

If you met Ethan Payton, he'd probably tell you about his recently earned graduate degree in international affairs or that he's learning to speak, read, and write in Arabic. He might mention his ambition to work for the government or a non-governmental organization that is involved in international development, particularly in the Middle East. But he probably would not tell you right away that he is a retired Army sergeant who lost his left arm in 2004 while deployed to Iraq-and given the lifelike appearance and function of his Ottobock Michelangelo Hand, you might not notice. Payton is too busy living life to make his injury a conversation piece.

"My military service and injury were a part of my life that happened, but now it's pretty much behind me," Payton says.

Payton joined the Army in 1997 at the age of 23. Shortly after being stationed in Germany he was deployed to Kosovo for six months. He went back to Germany for about a year and returned to the United States in 2001. He transitioned to the reserves and later became a student in the practical nursing program at what was then Walter Reed Army Medical Center (WRAMC), Washington DC. "That's where I met my wife, Laura, who was also in the Army and a nursing student," he says. "We were engaged before I was deployed to Iraq, and we were married in 2005."

Once in Baghdad, Payton's battalion was assigned to route clearance, which meant looking for improvised explosive devices. "We were on night patrol when my Humvee was struck with a rocket-propelled grenade," he recalls. "The blast came down through the gunner's hatch and almost severed my arm."

After undergoing amputation surgery and a short hospital stay in Germany, Payton returned to WRAMC, this time as a patient. He recuperated for a few weeks and then began receiving prosthetic care, along with physical and occupational therapy. "I think the fact that I got prosthetic care very quickly was a positive thing because I never really had a chance to adapt to doing things one-handed," he says. "I was fitted with an [Ottobock] SensorHand Speed, and very soon I was doing things with two hands again."

Electric positional thumb and key grasp pattern of the Michelangelo Hand.

Payton's prosthetist, John Miguelez, CP, president and senior clinical director of Advanced Arm Dynamics (AAD), headquartered in Redondo Beach, California, is quick to agree that early prosthetic fitting can be a key factor in helping individuals who undergo amputations become fluent prosthetic users. "When a patient is fit as soon as possible after losing a limb, there are both physical and psychological advantages," he says. "With expedited fitting, people can quickly increase their functional ability in daily activities, and rather than looking down at an empty shirt sleeve, they can start to incorporate the prosthesis into their body image. Add in simultaneous therapy and training, and high-activity patients like our American service members usually gain ground quickly."

New Upper-Limb Prosthetic Technology

As an injured veteran, Payton had unique access to some of the newest prosthetic technologies, including devices that were still in research and development. In 2007, Miguelez and his clinical team approached Payton about becoming one of the first people in the world to use the Michelangelo Hand as a beta test patient. "Ethan was a good candidate for several reasons," Miguelez said. "Since he had practical experience with numerous other types of prostheses, including a multiarticulating hand, he was in a strong position to provide comparative feedback on comfort, function, and appearance. We had enjoyed working with him as a prosthetic patient, and he had expressed an interest in learning more about emerging technologies."

At that time Payton had returned to the United States after living in Germany for two years, where his wife was stationed. "As soon as I heard about the opportunity to be a test patient, I was very interested," he says. "I wasn't starting school for a few months so I was available to travel. And I liked the idea of trying a prosthesis that offered an electric positional thumb and expanded grip patterns."

Being a test patient meant traveling to Ottobock in Vienna, Austria, where AAD clinicians were providing assessment and feedback during the initial development stages of the hand. "I really enjoyed the opportunity to go to Vienna twice and work with the engineers who designed the original product," Payton says. "We investigated many of the different aspects of the hand, from daily functionality to materials and strength." He remarked that with the Michelangelo Hand, his actions were "more spontaneous and natural" compared to other terminal devices he had used.

The automatic positioning of the electric thumb and the accompanying increased grip force contributes to the increased spontaneity that Payton says he has noticed, and that makes daily tasks such as grabbing a wallet, handling a DVD, and holding a plate of food easier. Once in position, the thumb locks, a security feature that is helpful when holding heavier objects or using a knife to cut food.

"Occupational therapy [OT] was emphasized throughout my beta-testing experience," Payton says. "An occupational therapist even came to my house to observe how I was using the prosthesis and help me with positioning and posture."

Payton learns to control his prosthesis with an occupational therapist.

According to Miguelez, the therapy team at AAD developed specific training protocols that maximize the benefits of multiarticulating hands. OT protocols for Payton included repetitive controls training; modified activities of daily living training related to specific features of the prosthesis, such as the electric positional thumb; and high-level independent living skills, including community integration and a follow-up OT visit to his home.

"I have been very fortunate to work with upper-limb therapists who really care about the actual functional progress their patients are able to make in real-world activities and situations," Payton says.

Following the second round of beta testing in Vienna, Payton returned home wearing an improved Michelangelo test prosthesis. And while he says that he wishes that the Michelangelo Hand included a wrist rotator-which Ottobock reports is currently under development-the lack thereof has not stopped it from becoming his go-to device.

Payton says the various grip patterns make it easier for him to accomplish daily tasks like cooking, walking his dog, and mowing the yard. He also appreciates the natural appearance of the hand with the cosmetic glove in place. He particularly likes that the wrist is flexible and durable. "The Michelangelo Hand just makes so many activities much easier-driving, pushing objects, or lifting objects like heavy boxes," he says. "I have put a lot of weight on the flexed wrist, and it's never broken. I also like how the wrist keeps me from having to contort my upper body to get in the best position to pick something up."

Miguelez agrees that reducing this sort of unnatural movement is an important advantage of having a flexible wrist. "In upper-limb prosthetics, we are very cognizant of how we can help patients maintain healthy alignment in the upper body," he says. "Without a flexible wrist, when a person uses their prosthesis to pick up an object, they will often raise their elbow or shoulder in an attempt to achieve a less awkward position for grasping. Over time, this type of compensatory movement can lead to issues with the shoulder and back."

Multiarticulating hands like the Michelangelo are an expansion of consumer options in upper-limb terminal devices. "After using numerous other prostheses, this hand has provided me with the best overall solution," Payton says. "Anatomically, it looks the most like a real hand and wrist, and the relaxed position of the hand is much more natural. The devices I've used in the past only had one grasp pattern, which is the three-point pinch. But the Michelangelo can transfer into different grasp patterns and this provides much more functionality."

"With four years of involvement in beta testing, and now wearing the hand every day, Ethan is one of the most experienced Michelangelo users in the world," Miguelez says.

Sherri Edge is a writer and video producer based in Oklahoma City, Oklahoma, and has written about prosthetics for more than 20 years.