title: Long-term follow-up evaluation of bilateral total hand loss.
abstract: OBJECTIVE
  Bilateral total hand loss is rare, and the challenges faced by the patient immediately after the loss are quite different from the long-term responses to the physical loss of both hands. This study evaluates the problems of these patients years after their injuries. The goal is to evaluate long-term adaptation to the loss and the degree of successful coping achieved by the patients.
  
  
  METHODS
  Seven subjects in this descriptive study participated in an interview and physical exam. They were asked about their physical, psychological, and social problems. Functional Independence Measure (FIM) and Functional Assessment Measure (FAM) were used to assess the levels of the major functional areas.
  
  
  RESULTS
  All of the subjects considered their handicap a serious disfigurement but not an impediment to finding a marriage partner or pursuing educational goals. All of the subjects, however, were dependent economically although they wanted to be employed based on their capabilities. Although 2 subjects used prostheses for activities of daily living, they all needed assistance for self-care. Three of the subjects had diagnosed psychological problems of anxiety and depression.
  
  
  CONCLUSIONS
  Bilateral total hand loss does not simply represent double the problems of unilateral hand loss. The problems resulting from the loss of both hands are physical, social, psychological, and economic and unique to these patients. The strength of the subjects came from having good family relations, stable environments, and family emotional support to help solve the numerous problems encountered on a daily basis. The subjects are able to maintain stable personal lives because they experience respect and comprehension of their problems by family members.
authors.affiliation: Department of Orthopaedics, Urmia University of Medical Sciences, Shahid Motahhari Hospital, Kashani Street, Urmia, Iran. afshar@umsu.ac.ir
authors.forename: Ahmadreza
authors.initials: A
authors.lastname: Afshar
authors.forename: Neda
authors.initials: N
authors.lastname: Afshar
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000503:physiopathology / Q000523:psychology*; D000674:Amputees / Q000523:psychology*; D001007:Anxiety / Q000209:etiology; D001186:Artificial Limbs; D001753:Blast Injuries / Q000503:physiopathology / Q000523:psychology; D017028:Caregivers; D002648:Child; D003863:Depression / Q000209:etiology; D004954:Esthetics; D005190:Family / Q000523:psychology; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D007492:Iran; D008297:Male; D012648:Self Care; D012923:Social Class; D014478:Unemployment