A vocational rehabilitation consumer who independently owned a home metal jewelry making business was unable to resume her business after she suffered a stroke. Due to right side hemiparesis as a result of the stroke, she experienced significant difficulties in accessing several of the apparatuses used to create the designs of the jewelry. Rehabilitation Engineers (RE) first conducted a step-by-step task analysis. Then, RE provided assistive technology interventions through fabricating customized modifications and identifying commercially available solutions that could be controlled through other areas of her body unaffected by the stroke or one-handed procedure.
Jewelry making, Stroke, Hemiparesis, Fabrication, and Vocational Rehabilitation.
This case study involves a consumer who independently owned a home metal jewelry making business prior to suffering a stroke in June of 2004. For fifteen years, the consumer has been designing and creating jewelry from her home worksite. The consumer is a 53 year-old female who has aphasia and right side hemiparesis as a result of the stroke. Her right hand was her dominant hand.
After the stroke, she received physical and occupational therapy for mobility and activities of daily living. By May 2005, she was able to ambulate independently without a cane. At home, she was prescribed to wear a dynamic orthotic hand splint at 45 minutes intervals, twice a day to improve functions in her musculoskeletal and nervous system of the right hand.
Despite improvements to her fine motor functions and increased strength in right upper and lower extremities, she has been unable to resume operations of her jewelry business. She was referred to the Rehabilitation Technology Department Massachusetts Rehabilitation Commission (MRC) by her MRC Vocational Rehabilitation (VR) counselor to develop assistive technology interventions.
The jewelry making process involved several steps. Most of the steps required the use of both hands. Prior to the stroke, the consumer used her left hand to support her right hand for most tasks. In addition, she reported significant difficulties in accessing several of the apparatuses used to create the designs of the jewelry. During the summer of 2005, she attempted to make a pair of sterling silver earrings. She used 3.5 hours to complete the task, which typically took her 15 minutes prior to stroke.
Rehabilitation Engineers (RE) sought to fabricate customized modifications and identify commercially available solutions that could be used in each step of jewelry making procedures. In particular, RE wanted to identify alternative ways for the consumer to operate apparatus through utilizing other areas of her body unaffected by the stroke such as left upper extremity, left lower extremity and head control movements.
To design effective work-site modifications, RE first conducted a task analysis of how consumer access tools and equipment in each step of jewelry making. With individual task demonstrations and input from the consumer, RE defined eight major steps: (1) cutting the metal, (2) embossing patterns or thinning of the metal through the mill, (3) forming the metal with dapping punches, hammer and dapping blocks, (4) twisting the metal into various patterns, (5) polishing the metal through filing, sanding, or pendant drill polishing, (6) annealing the metal by using a soldering torch, (7) pickling to remove the flux in soldering process, and (8) packaging the jewelry for shipment. Client determined that steps 1, 3, 4 and 6 were most challenging for her at this time. These were the steps RE focused on developing assistive technology interventions.
In Step 1, the consumer previously laid the sheet metal on the metal cutting press, measured the desired cutting length against the side ruler, stabilized the sheet with the left hand and pulled the lever with the right hand. Presently, the consumer is unable to safely hold the sheet with her right hand and operating the lever. To modify this process, RE moved the side ruler towards the middle of the platform so consumer could hold metal piece against the ruler with her left hand. The lever was hinged to a long piece of plywood with a foot pedal attached to it. This adaptation allowed the consumer to operate the lever with foot control.
In Step 3, the consumer formerly held a dapping punch (cylindrical steel rods with a spherical bulb on one end) on top of the metal piece with her left hand and hammered the dapping punch onto a dapping block (block of steel in which half-sphere impressions are cut) to shape the metal with her right hand. RE adapted this step to a one-handed procedure through designing a jig with different sizes of dapping punch. This allowed the consumer to place metal piece on the dapping block, cover the block with jig adjusting for specific diameter of dapping punch, insert the dapping punch through the jig, and then hammer dapping punch with accuracy.
In Step 4, before the stroke, the consumer made the different jewelry pattern by using hand tools. RE found a commercially available Wig Jig with adjustable metal pegs, which can be arranged to create different jewelry design patterns.
In Step 6, consumer typically must hold the solder, soldering torch and metal piece during the annealing process. This tasks required high-level precision even prior to the stroke. RE identified several tools to assist in this process. A GRS Double Third Hand Soldering Station was purchased to mount the metal piece. Then, RE modified a commercially available adjustable head pointer device to load the solder and guide the solder towards the annealing location with a tungsten claw clamp. The combination of soldering station and head pointer solder mount freed the consumer's left hand to manipulate the soldering torch.
The consumer has received training from RE on how to use each of the modifications. Through practice, she has become more efficient in performing each step with modified tools and equipment. She stated that she anticipates that she will begin to take small orders in the next few months.
RE examined different approaches before the final modifications were made. In particular, RE investigated the possibility of automatic jewelry making apparatuses to replace consumer's manual apparatuses. However, RE discovered that very few automated tools and equipment for artisan metal jewelry making existed. Furthermore, many jewelry artisans with disabilities specialized in bead jewelry or focused only on jewelry design. With the consumer's strong desire to continue making the jewelry, RE began to consider assistive technology interventions, which would utilize motor function unaffected by the stroke. This type of motor function asset approach became very effective in developing solutions.
An additional challenge that RE at the Massachusetts Rehabilitation Commission (MRC) had to overcome was identifying fabrication facilities to implement modification designs. MRC has traditional delivered assistive technology services through a community-based rehabilitation provider network. Members of this network have been able to address the alternative computer access, ergonomic, environmental control system, and augmentative communication needs through commercially available assistive technology. However, these subcontracted community organizations lacked the capacity for fabrication and unique job sit modifications. In order to serve this client, RE at MRC tapped into assistive technology lab facility at the Hogan Regional Centers operated by Massachusetts Department of Mental Retardation (DMR), which did have the in-house capability to fabricate design and build customized jigs. To facilitate the cross-sharing of state agency resources, RE from MRC build an interagency collaboration pilot project with RE from DMR Hogan Center to exchange AT services between DMR consumers and MRC consumer. It is through this vital interagency collaboration that this consumer was successful served.
This consumer was served through a regional interagency collaboration pilot project between Massachusetts Rehabilitation Commission and Massachusetts Department of Mental Retardation Hogan Regional Center
Sue Chien-shy Lin, M.S.
Rehabilitation Technology Department
Massachusetts Rehabilitation Commission
27 Wormwood St. Suite 600
Boston, MA 02210
Voice: (617)204-3813 Fax: (617)727-1354
Email: sue.lin@MRC.state.ma.us
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