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Engdahl SM, Gonzalez MA, Lee C, Gates DH. Perspectives on the comparative benefits of body-powered and myoelectric upper limb prostheses. J Neuroeng Rehabil 2024; 21:138. [PMID: 39118106 PMCID: PMC11308580 DOI: 10.1186/s12984-024-01436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/28/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Patient access to body-powered and myoelectric upper limb prostheses in the United States is often restricted by a healthcare system that prioritizes prosthesis prescription based on cost and perceived value. Although this system operates on an underlying assumption that design differences between these prostheses leads to relative advantages and disadvantages of each device, there is limited empirical evidence to support this view. MAIN TEXT This commentary article will review a series of studies conducted by our research team with the goal of differentiating how prosthesis design might impact user performance on a variety of interrelated domains. Our central hypothesis is that the design and actuation method of body-powered and myoelectric prostheses might affect users' ability to access sensory feedback and account for device properties when planning movements. Accordingly, other domains that depend on these abilities may also be affected. While our work demonstrated some differences in availability of sensory feedback based on prosthesis design, this did not result in consistent differences in prosthesis embodiment, movement accuracy, movement quality, and overall kinematic patterns. CONCLUSION Collectively, our findings suggest that performance may not necessarily depend on prosthesis design, allowing users to be successful with either device type depending on the circumstances. Prescription practices should rely more on individual needs and preferences than cost or prosthesis design. However, we acknowledge that there remains a dearth of evidence to inform decision-making and that an expanded research focus in this area will be beneficial.
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Affiliation(s)
- Susannah M Engdahl
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | | | - Christina Lee
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Deanna H Gates
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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2
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Henderson E, Rehani M, Hebert JS. Sex and gender differences in upper extremity prosthesis rejection: A review of literature. Prosthet Orthot Int 2024; 48:300-314. [PMID: 38579197 DOI: 10.1097/pxr.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/30/2023] [Indexed: 04/07/2024]
Abstract
Prosthesis rejection is a significant barrier to rehabilitation of persons with upper limb difference. Many individual factors can affect device rejection, including a person's sex or gender. The objective of this narrative review was to explore the reported differences between the sexes and genders in upper limb prosthesis rejection. This review considered peer-reviewed, published research studies in which the study population were adults (aged 18 and older) who had unilateral or bilateral limb difference (any level) of any etiology with current, past, or no history of prosthetic device usage. Using identified keywords, index terms, and a peer-reviewed search filter, the literature was searched in MEDLINE, Embase, and PsycInfo. The reasons for rejection, disuse, or abandonment of prosthetic devices were extracted, with the focus on reported differences between sex and genders. After searching, 29 articles were selected for full-text review and 15 were included. Only 5 of 15 articles examined differences between the sexes. Women tend to reject upper extremity prostheses more than men both before and after being fit with a device; device characteristics, such as weight and cosmesis, do not appear to be appropriately designed for women; and there may not be adequate consideration of the goals for women with limb difference(s). There is inadequate reporting of sex and gender in the literature on prosthesis rejection; future studies should report and explore these factors to determine whether the needs of the full population with limb loss are being met.
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Affiliation(s)
- Eric Henderson
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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3
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Shimizu Y, Mori T, Yoshikawa K, Katane D, Torishima H, Hara Y, Yozu A, Yamazaki M, Hada Y, Mutsuzaki H. Developing a Novel Prosthetic Hand with Wireless Wearable Sensor Technology Based on User Perspectives: A Pilot Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2765. [PMID: 38732871 PMCID: PMC11086240 DOI: 10.3390/s24092765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
Myoelectric hands are beneficial tools in the daily activities of people with upper-limb deficiencies. Because traditional myoelectric hands rely on detecting muscle activity in residual limbs, they are not suitable for individuals with short stumps or paralyzed limbs. Therefore, we developed a novel electric prosthetic hand that functions without myoelectricity, utilizing wearable wireless sensor technology for control. As a preliminary evaluation, our prototype hand with wireless button sensors was compared with a conventional myoelectric hand (Ottobock). Ten healthy therapists were enrolled in this study. The hands were fixed to their forearms, myoelectric hand muscle activity sensors were attached to the wrist extensor and flexor muscles, and wireless button sensors for the prostheses were attached to each user's trunk. Clinical evaluations were performed using the Simple Test for Evaluating Hand Function and the Action Research Arm Test. The fatigue degree was evaluated using the modified Borg scale before and after the tests. While no statistically significant differences were observed between the two hands across the tests, the change in the Borg scale was notably smaller for our prosthetic hand (p = 0.045). Compared with the Ottobock hand, the proposed hand prosthesis has potential for widespread applications in people with upper-limb deficiencies.
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Affiliation(s)
- Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
- Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Takahiko Mori
- Department of Electrical and Electronic Engineering, Shonan Institute of Technology, Fujisawa 251-8511, Japan
| | - Kenichi Yoshikawa
- Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Daisuke Katane
- Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Hiroyuki Torishima
- Saitama Prosthetics and Orthotics Manufacturing Service Co., Ltd., Saitama 337-0051, Japan
| | - Yuki Hara
- Department of Neurophysiology, National Center of Neurology and Psychiatry, Kodaira 187-8551, Japan
| | - Arito Yozu
- Department of Precision Engineering, University of Tokyo, Bunkyo 113-8656, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Hirotaka Mutsuzaki
- Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0331, Japan
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4
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Dizon LML, Leochico CFD, Ramirez RS, Rey-Matias RR. A scoping review on upper extremity prostheses: Satisfaction, barriers, and their implications in resource-limited countries. Prosthet Orthot Int 2024:00006479-990000000-00235. [PMID: 38517392 DOI: 10.1097/pxr.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
The rates of prosthetic abandonment are not extensively understood especially in resource-limited countries. A scoping review was conducted to examine the literature on the satisfaction with and barriers to using specifically upper limb prostheses. A systematic search of the literature identified 425 studies. After reviewing the articles using predetermined inclusion and exclusion criteria, 7 cross-sectional studies were included in the final review. Barriers to the use of upper limb prostheses include the characteristics of the prosthesis (type, comfort, weight, functionality, price, and availability) and individual patient factors (recent prosthetic user, level of amputation, congenital and accidental limb loss, pain, and duration between amputation and prosthetic fitting). Considering tailored prosthetic design and funding may result in improved prosthetic adherence.
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Affiliation(s)
- Lorenzo Martin L Dizon
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
| | - Carl Froilan D Leochico
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global City, Philippines
- Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Department of Medicine (Division of Neurology) and Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Reykjavik S Ramirez
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
- Department of Rehabilitation Medicine, Allied Care Experts Medical Center, Quezon City, Philippines
- Department of Rehabilitation Medicine, Allied Care Experts Medical Center, Valenzuela City, Philippines
| | - Reynaldo R Rey-Matias
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global City, Philippines
- Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Gavette H, McDonald CL, Kostick-Quenet K, Mullen A, Najafi B, Finco MG. Advances in prosthetic technology: a perspective on ethical considerations for development and clinical translation. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1335966. [PMID: 38293290 PMCID: PMC10824968 DOI: 10.3389/fresc.2023.1335966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024]
Abstract
Technological advancements of prostheses in recent years, such as haptic feedback, active power, and machine learning for prosthetic control, have opened new doors for improved functioning, satisfaction, and overall quality of life. However, little attention has been paid to ethical considerations surrounding the development and translation of prosthetic technologies into clinical practice. This article, based on current literature, presents perspectives surrounding ethical considerations from the authors' multidisciplinary views as prosthetists (HG, AM, CLM, MGF), as well as combined research experience working directly with people using prostheses (AM, CLM, MGF), wearable technologies for rehabilitation (MGF, BN), machine learning and artificial intelligence (BN, KKQ), and ethics of advanced technologies (KKQ). The target audience for this article includes developers, manufacturers, and researchers of prosthetic devices and related technology. We present several ethical considerations for current advances in prosthetic technology, as well as topics for future research, that may inform product and policy decisions and positively influence the lives of those who can benefit from advances in prosthetic technology.
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Affiliation(s)
- Hayden Gavette
- Orthotics and Prosthetics Program, School of Health Professions, Baylor College of Medicine, Houston, TX, United States
| | - Cody L. McDonald
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Ashley Mullen
- Orthotics and Prosthetics Program, School of Health Professions, Baylor College of Medicine, Houston, TX, United States
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance Lab (iCAMP), Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - M. G. Finco
- Orthotics and Prosthetics Program, School of Health Professions, Baylor College of Medicine, Houston, TX, United States
- Interdisciplinary Consortium on Advanced Motion Performance Lab (iCAMP), Department of Surgery, Baylor College of Medicine, Houston, TX, United States
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Resnik LJ, Borgia M, Clark MA, Ni P. Out-of-pocket costs and affordability of upper limb prostheses. Prosthet Orthot Int 2024; 48:108-114. [PMID: 36897203 DOI: 10.1097/pxr.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/18/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Given the funding policies in the Department of Veterans Affairs, the affordability of prostheses may be less of a concern among Veterans as compared to civilians. OBJECTIVES Compare rates of out-of-pocket prosthesis-related payments for Veterans and non-Veterans with upper limb amputation (ULA), develop and validate a measure of prosthesis affordability, and evaluate the impact of affordability on prosthesis nonuse. STUDY DESIGN Telephone survey of 727 persons with ULA; 76% Veterans and 24% non-Veterans. METHODS Odds of paying out-of-pocket costs for Veterans compared with non-Veterans were computed using logistic regression. Cognitive and pilot testing resulted in a new scale, evaluated using confirmatory factor and Rasch analysis. Proportions of respondents who cited affordability as a reason for never using or abandoning a prosthesis were calculated. RESULTS Twenty percent of those who ever used a prosthesis paid out-of-pocket costs. Veterans had 0.20 odds (95% confidence interval, 0.14-0.30) of paying out-of-pocket costs compared with non-Veterans. Confirmatory factor analysis supported unidimensionality of the 4-item Prosthesis Affordability scale. Rasch person reliability was 0.78. Cronbach alpha was 0.87. Overall, 14% of prosthesis never-users said affordability was a reason for nonuse; 9.6% and 16.5% of former prosthesis users said affordability of repairs or replacement, respectively, was a reason for abandonment. CONCLUSIONS Out-of-pocket prosthesis costs were paid by 20% of those sample, with Veterans less likely to incur costs. The Prosthesis Affordability scale developed in this study was reliable and valid for persons with ULA. Prosthesis affordability was a common reason for never using or abandoning prostheses.
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Affiliation(s)
- Linda J Resnik
- Research Department, Providence VA Medical Center, Providence, RI
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI
| | - Matthew Borgia
- Research Department, Providence VA Medical Center, Providence, RI
| | - Melissa A Clark
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI
- University of Massachusetts Medical School, Worcester, MA
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA
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Lightdale-Miric N, Tuberty S, Nelson D. Caring for Children With Congenital Upper Extremity Differences. J Hand Surg Am 2021; 46:1105-1111. [PMID: 34548182 DOI: 10.1016/j.jhsa.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/21/2021] [Accepted: 07/02/2021] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to provide information about the changing landscapes in research, treatment, civil rights' protection, disability awareness, and accepted terminology in the care of children with congenital upper limb differences. This knowledge can guide clinical and nonclinical conversations between patients and their families.
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Affiliation(s)
- Nina Lightdale-Miric
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
| | - Sarah Tuberty
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Danielle Nelson
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
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Salminger S, Stino H, Pichler LH, Gstoettner C, Sturma A, Mayer JA, Szivak M, Aszmann OC. Current rates of prosthetic usage in upper-limb amputees - have innovations had an impact on device acceptance? Disabil Rehabil 2020; 44:3708-3713. [PMID: 33377803 DOI: 10.1080/09638288.2020.1866684] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE There is a large body of evidence demonstrating high rates of prosthesis abandonment in the upper extremity. However, these surveys were conducted years ago, thus the influence of recent refinements in prosthetic technology on acceptance is unknown. This study aims to gather current data on prosthetic usage, to assess the effects of these advancements. MATERIALS AND METHODS A questionnaire was sent to 68 traumatic upper limb amputees treated within the Austrian Trauma Insurance Agency between the years 1996 and 2016. Responses were grouped by the year of amputation to assess the effect of time. RESULTS The rejection rate at all levels of amputation was 44%. There was no significant difference in acceptance between responders amputated before or after 2006 (p = 0.939). Among users, 92.86% (n = 13) used a myoelectric, while only one amputee (7.14%, n = 1) used a body-powered device. Most responders complained about the comfort (60.87%, n = 14) as well as the weight of the device (52.17%, n = 12). CONCLUSIONS The advancements of the last decade in the arena of upper limb prosthetics have not yet achieved a significant change in prosthetic abandonment within this study cohort. Although academic solutions have been presented to tackle patient's complaints, clinical reality still shows high rejection rates of cost-intensive prosthetic devices.Implications for rehabilitationAbandonment rates in prosthetic rehabilitation after upper limb amputation have shown to be 50% and higher.The advancements of the last decade in the arena of upper limb prosthetics have not yet achieved a significant change in prosthetic abandonment.Well-structured and patient-tailored prosthetic training as well as ensuring the amputee's active participation in the decision making process will most likely improve prosthetic acceptance.
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Affiliation(s)
- Stefan Salminger
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria.,Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | - Heiko Stino
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | | | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria.,Department of Bioengineering, Imperial College London, London, UK
| | - Johannes A Mayer
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
| | - Michael Szivak
- Department of Medical Documentation and Statistics, Austrian Trauma Insurance Agency (AUVA), Vienna, Austria
| | - Oskar C Aszmann
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria.,Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
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Stenvall E, Flodberg G, Pettersson H, Hellberg K, Hermansson L, Wallin M, Yang L. Additive Manufacturing of Prostheses Using Forest-Based Composites. Bioengineering (Basel) 2020; 7:bioengineering7030103. [PMID: 32882934 PMCID: PMC7552696 DOI: 10.3390/bioengineering7030103] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
A custom-made prosthetic product is unique for each patient. Fossil-based thermoplastics are the dominant raw materials in both prosthetic and industrial applications; there is a general demand for reducing their use and replacing them with renewable, biobased materials. A transtibial prosthesis sets strict demands on mechanical strength, durability, reliability, etc., which depend on the biocomposite used and also the additive manufacturing (AM) process. The aim of this project was to develop systematic solutions for prosthetic products and services by combining biocomposites using forestry-based derivatives with AM techniques. Composite materials made of polypropylene (PP) reinforced with microfibrillated cellulose (MFC) were developed. The MFC contents (20, 30 and 40 wt%) were uniformly dispersed in the polymer PP matrix, and the MFC addition significantly enhanced the mechanical performance of the materials. With 30 wt% MFC, the tensile strength and Young´s modulus was about twice that of the PP when injection molding was performed. The composite material was successfully applied with an AM process, i.e., fused deposition modeling (FDM), and a transtibial prosthesis was created based on the end-user’s data. A clinical trial of the prosthesis was conducted with successful outcomes in terms of wearing experience, appearance (color), and acceptance towards the materials and the technique. Given the layer-by-layer nature of AM processes, structural and process optimizations are needed to maximize the reinforcement effects of MFC to eliminate variations in the binding area between adjacent layers and to improve the adhesion between layers.
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Affiliation(s)
- Erik Stenvall
- Stora Enso AB, Sommargatan 101A, 65009 Karlstad, Sweden;
| | - Göran Flodberg
- RISE—Research Institutes of Sweden, Drottning Kristinas väg 61, 11486 Stockholm, Sweden; (G.F.); (H.P.)
| | - Henrik Pettersson
- RISE—Research Institutes of Sweden, Drottning Kristinas väg 61, 11486 Stockholm, Sweden; (G.F.); (H.P.)
| | | | - Liselotte Hermansson
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, 70185 Örebro, Sweden or (L.H.); (M.W.)
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 70185 Örebro, Sweden
| | - Martin Wallin
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, 70185 Örebro, Sweden or (L.H.); (M.W.)
| | - Li Yang
- RISE—Research Institutes of Sweden, Drottning Kristinas väg 61, 11486 Stockholm, Sweden; (G.F.); (H.P.)
- Correspondence: ; Tel.: +46-76-8767-134
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Obstacles to Prosthetic Care—Legal and Ethical Aspects of Access to Upper and Lower Limb Prosthetics in Germany and the Improvement of Prosthetic Care from a Social Perspective. SOCIETIES 2020. [DOI: 10.3390/soc10010010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prosthetic technology for people with missing limbs has made great progress in recent decades. However, acceptance rates and user satisfaction are not only dependent on technical aspects, but also to a great extent on social and psychological factors. We propose that these factors should receive greater attention in order to improve prosthetic care and give recommendations how to incorporate the findings from social science in research and development (R&D) and in care practice. Limited access due to high costs of new prosthetic technology combined with rising costs in health care systems in general is a further issue we address. Our legal and ethical analysis of the reimbursement process in Germany shows that this issue requires further empirical investigation, a stakeholder dialogue and maybe even policy changes. Social science knowledge and participatory methods are of high relevance to answer questions about the benefit of prosthetics for users, based on individual needs and preferences, which should be at the core of debates on ethical resource allocation.
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Widehammar C, Pettersson I, Janeslätt G, Hermansson L. The influence of environment: Experiences of users of myoelectric arm prosthesis-a qualitative study. Prosthet Orthot Int 2018; 42:28-36. [PMID: 28470129 PMCID: PMC5808811 DOI: 10.1177/0309364617704801] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prostheses are used to varying degrees; however, little is known about how environmental aspects influence this use. OBJECTIVES To describe users' experiences of how environmental factors influence their use of a myoelectric arm prosthesis. STUDY DESIGN Qualitative and descriptive. METHODS A total of 13 patients previously provided with a myoelectric prosthetic hand participated. Their age, sex, deficiency level, etiology, current prosthesis use, and experience varied. Semi-structured interviews were audiotaped, transcribed, and analyzed through inductive content analysis. RESULTS Four categories were created from the data: "Prosthesis function," "Other people's attitudes," "Support from family and healthcare," and "Individual's attitude and strategies." The overarching theme, "Various degrees of embodiment lead to different experiences of environmental barriers and facilitators," emerged from differences in individual responses depending on whether the individual was a daily or a non-daily prosthesis user. Environmental facilitators such as support from family and healthcare and good function and fit of the prosthesis seemed to help the embodiment of the prosthesis, leading to daily use. This embodiment seemed to reduce the influence of environmental barriers, for example, climate, attitudes, and technical shortcomings. CONCLUSION Embodiment of prostheses seems to reduce the impact of environmental barriers. Support and training may facilitate the embodiment of myoelectric prosthesis use. Clinical relevance For successful prosthetic rehabilitation, environmental factors such as support and information to the patient and their social network about the benefits of prosthesis use are important. Local access to training in myoelectric control gives more people the opportunity to adapt to prosthesis use and experience less environmental barriers.
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Affiliation(s)
- Cathrine Widehammar
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Department of Prosthetics and Orthotics, Faculty of Medicicne and Health, Örebro University, Örebro, Sweden,Cathrine Widehammar, Faculty of Medicine and Health, Örebro University, Örebro 70281, Sweden.
| | | | | | - Liselotte Hermansson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden,Department of Prosthetics and Orthotics, Faculty of Medicicne and Health, Örebro University, Örebro, Sweden
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13
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Hichert M, Abbink DA, Kyberd PJ, Plettenburg DH. High Cable Forces Deteriorate Pinch Force Control in Voluntary-Closing Body-Powered Prostheses. PLoS One 2017; 12:e0169996. [PMID: 28099454 PMCID: PMC5242472 DOI: 10.1371/journal.pone.0169996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/27/2016] [Indexed: 11/28/2022] Open
Abstract
Background It is generally asserted that reliable and intuitive control of upper-limb prostheses requires adequate feedback of prosthetic finger positions and pinch forces applied to objects. Body-powered prostheses (BPPs) provide the user with direct proprioceptive feedback. Currently available BPPs often require high cable operation forces, which complicates control of the forces at the terminal device. The aim of this study is to quantify the influence of high cable forces on object manipulation with voluntary-closing prostheses. Method Able-bodied male subjects were fitted with a bypass-prosthesis with low and high cable force settings for the prehensor. Subjects were requested to grasp and transfer a collapsible object as fast as they could without dropping or breaking it. The object had a low and a high breaking force setting. Results Subjects conducted significantly more successful manipulations with the low cable force setting, both for the low (33% more) and high (50%) object’s breaking force. The time to complete the task was not different between settings during successful manipulation trials. Conclusion High cable forces lead to reduced pinch force control during object manipulation. This implies that low cable operation forces should be a key design requirement for voluntary-closing BPPs.
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Affiliation(s)
- Mona Hichert
- Delft Institute of Prosthetics and Orthotics, Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- * E-mail:
| | - David A. Abbink
- Delft Haptics Lab, Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Peter J. Kyberd
- Institute of Biomedical Engineering University of New Brunswick, Fredericton, Canada
- Department of Engineering Science, University of Greenwich, Chatham Maritime, United Kingdom
| | - Dick H. Plettenburg
- Delft Institute of Prosthetics and Orthotics, Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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14
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Etter K, Borgia M, Resnik L. Prescription and repair rates of prosthetic limbs in the VA healthcare system: implications for national prosthetic parity. Disabil Rehabil Assist Technol 2014; 10:493-500. [DOI: 10.3109/17483107.2014.921246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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