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Mamidanna P, Gholinezhad S, Farina D, Dideriksen JL, Dosen S. Measuring and monitoring skill learning in closed-loop myoelectric hand prostheses using speed-accuracy tradeoffs. J Neural Eng 2024; 21:026008. [PMID: 38417146 DOI: 10.1088/1741-2552/ad2e1c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/28/2024] [Indexed: 03/01/2024]
Abstract
Objective.Closed-loop myoelectric prostheses, which combine supplementary sensory feedback and electromyography (EMG) based control, hold the potential to narrow the divide between natural and bionic hands. The use of these devices, however, requires dedicated training. Therefore, it is crucial to develop methods that quantify how users acquire skilled control over their prostheses to effectively monitor skill progression and inform the development of interfaces that optimize this process.Approach.Building on theories of skill learning in human motor control, we measured speed-accuracy tradeoff functions (SAFs) to comprehensively characterize learning-induced changes in skill-as opposed to merely tracking changes in task success across training-facilitated by a closed-loop interface that combined proportional control and EMG feedback. Sixteen healthy participants and one individual with a transradial limb loss participated in a three-day experiment where they were instructed to perform the box-and-blocks task using a timed force-matching paradigm at four specified speeds to reach two target force levels, such that the SAF could be determined.Main results.We found that the participants' accuracy increased in a similar way across all speeds we tested. Consequently, the shape of the SAF remained similar across days, at both force levels. Further, we observed that EMG feedback enabled participants to improve their motor execution in terms of reduced trial-by-trial variability, a hallmark of skilled behavior. We then fit a power law model of the SAF, and demonstrated how the model parameters could be used to identify and monitor changes in skill.Significance.We comprehensively characterized how an EMG feedback interface enabled skill acquisition, both at the level of task performance and movement execution. More generally, we believe that the proposed methods are effective for measuring and monitoring user skill progression in closed-loop prosthesis control.
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Affiliation(s)
- Pranav Mamidanna
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Shima Gholinezhad
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | | | - Strahinja Dosen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Maas B, Van Der Sluis CK, Bongers RM. Assessing the effectiveness of serious game training designed to assist in upper limb prothesis rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1353077. [PMID: 38348457 PMCID: PMC10859406 DOI: 10.3389/fresc.2024.1353077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024]
Abstract
Introduction Controlling a myoelectric upper limb prosthesis is difficult, therefore training is required. Since training with serious games showed promising results, the current paper focuses on game design and its effectivity for transfer between in-game skill to actual prosthesis use for proportional control of hand opening and control of switching between grips. We also examined training duration and individual differences. Method Thirty-six participants were randomly assigned to one of three groups: a task-specific serious game training group, a non-task-specific serious game training group and a control group. Each group performed a pre-test, mid-test and a post-test with five training sessions between each test moment. Test sessions assessed proportional control using the Cylinder test, a test designed to measure scaling of hand aperture during grabbing actions, and the combined use of proportional and switch control using the Clothespin Relocation Test, part of the Southampton Hand Assessment Procedure and Tray Test. Switch control was assessed during training by measuring amplitude difference and phasing of co-contraction triggers. Results Differences between groups over test sessions were observed for proportional control tasks, however there was lack of structure in these findings. Maximum aperture changed with test moment and some participants adjusted maximum aperture for smaller objects. For proportional and switch control tasks no differences between groups were observed. The effect of test moment suggests a testing effect. For learning switch control, an overall improvement across groups was found in phasing of the co-contraction peaks. Importantly, individual differences were found in all analyses. Conclusion As improvements over test sessions were found, but no relevant differences between groups were revealed, we conclude that transfer effects from game training to actual prosthesis use did not take place. Task specificity nor training duration had effects on outcomes. Our results imply testing effects instead of transfer effects, in which individual differences played a significant role. How transfer from serious game training in upper limb prosthesis use can be enhanced, needs further attention.
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Affiliation(s)
- Bart Maas
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Corry K. Van Der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Raoul M. Bongers
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Heerschop A, van der Sluis CK, Bongers RM. Training prosthesis users to switch between modes of a multi-articulating prosthetic hand. Disabil Rehabil 2024; 46:187-198. [PMID: 36541182 DOI: 10.1080/09638288.2022.2157055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Producing triggers to switch between modes of myoelectric prosthetic hands has proven to be difficult. We evaluated whether digital training methods were feasible in individuals with an upper limb defect (ULD), whether myosignals in these individuals differ from those of non-impaired individuals and whether acquired skills transfer to prosthesis use. MATERIALS AND METHODS Two groups participated in a 9-day pre-test-post-test design study with seven 45-minute training sessions. One group trained using a serious game, the other with their myosignals digitally displayed. Both groups also trained using a prosthesis. The pre- and post-tests consisted of an adapted Clothespin Relocation Test and the spherical subset of the Southampton Hand Assessment Procedure. After the post-test, the System Usability Scale (SUS) was administered. Clinically relevant performance measures and myosignal features were analysed. RESULTS Four individuals with a ULD participated. SUS-scores deemed both training methods feasible. Three participants produced only a few correct triggers. Myosignals features indicated larger variability for individuals with a ULD compared to non-impaired individuals (previously published data [1]). Three participants indicated transfer of skill. CONCLUSIONS Even though both training methods were deemed feasible and most participants showed transfer, seven training sessions were insufficient to learn reliable switching behaviour.Trial registration: The study was approved by the medical ethics committee of the University Medical Center Groningen (METc 2018.268).Implications for rehabilitationSwitching between pre-programmed modes of a myoelectric prosthetic hand can be learned, however it does require training.Serious games can be considered useful training tools for trigger production in early phases of myoelectric prosthesis control training.In order to evoke transfer of skill from training to daily life both task-specificity and focus of attention during training should be taken into account.
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Affiliation(s)
- A Heerschop
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R M Bongers
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Denduluri SK, Rees A, Nord KM, Loeffler BJ, Gaston RG. The Starfish Procedure for Independent Digital Control of a Myoelectric Prosthesis. Tech Hand Up Extrem Surg 2023; 27:61-67. [PMID: 36189486 DOI: 10.1097/bth.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Management of partial hand amputations is a notable clinical challenge. Historically, myoelectric prostheses have not allowed for independent digital control, resulting in unsatisfactory function and high rejection rates among upper extremity amputees. The Starfish Procedure was developed for patients who sustained loss of multiple digits through the level of the base of the proximal phalanx or distal metacarpal. The procedure involves the pedicled transfer of 1 or more dorsal interosseous muscles to a subcutaneous location. This allows for a myoelectric sensor to capture the signals generated by these transferred muscles, thereby enabling intuitive, independent, digital prosthetic flexion and extension. In this article, we detail the relevant anatomy, indications, and technique for performing the Starfish Procedure. Given our patients' promising outcomes to date, we hope this technique paper will encourage upper extremity surgeons of all training backgrounds to perform this relatively straightforward procedure, thereby allowing patients with life-altering finger amputations to regain meaningful function by enhancing control of digital prostheses.
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Affiliation(s)
- Sahitya K Denduluri
- OrthoCarolina Hand Center and Atrium Musculoskeletal Institute, Charlotte, North Carolina, USA
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Parr JVV, Galpin A, Uiga L, Marshall B, Wright DJ, Franklin ZC, Wood G. A tool for measuring mental workload during prosthesis use: The Prosthesis Task Load Index (PROS-TLX). PLoS One 2023; 18:e0285382. [PMID: 37141379 PMCID: PMC10159192 DOI: 10.1371/journal.pone.0285382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 04/21/2023] [Indexed: 05/06/2023] Open
Abstract
When using a upper-limb prosthesis, mental, emotional, and physical effort is often experienced. These have been linked to high rates of device dissatisfaction and rejection. Therefore, understanding and quantifying the complex nature of workload experienced when using, or learning to use, a upper-limb prosthesis has practical and clinical importance for researchers and applied professionals. The aim of this paper was to design and validate a self-report measure of mental workload specific to prosthesis use (The Prosthesis Task Load Index; PROS-TLX) that encapsulates the array of mental, physical, and emotional demands often experienced by users of these devices. We first surveyed upper-limb prosthetic limb users who confirmed the importance of eight workload constructs taken from published literature and previous workload measures. These constructs were mental demands, physical demands, visual demands, conscious processing, frustration, situational stress, time pressure and device uncertainty. To validate the importance of these constructs during initial prosthesis learning, we then asked able-bodied participants to complete a coin-placement task using their anatomical hand and then using a myoelectric prosthesis simulator under low and high mental workload. As expected, using a prosthetic hand resulted in slower movements, more errors, and a greater tendency to visually fixate the hand (indexed using eye-tracking equipment). These changes in performance were accompanied by significant increases in PROS-TLX workload subscales. The scale was also found to have good convergent and divergent validity. Further work is required to validate whether the PROS-TLX can provide meaningful clinical insights to the workload experienced by clinical users of prosthetic devices.
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Affiliation(s)
- Johnny V V Parr
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Adam Galpin
- School of Health and Society, University of Salford, Manchester, United Kingdom
| | - Liis Uiga
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Ben Marshall
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - David J Wright
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Zoe C Franklin
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Greg Wood
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
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Effect of the Thumb Orientation and Actuation on the Functionality and Performance of Affordable Prosthetic Hands: Obtaining Design Criteria. Biomimetics (Basel) 2022; 7:biomimetics7040233. [PMID: 36546933 PMCID: PMC9775784 DOI: 10.3390/biomimetics7040233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The advent of 3D printing technologies has enabled the development of low-cost prosthetic underactuated hands, with cables working as tendons for flexion. Despite the particular relevance to human grasp, its conception in prosthetics is based on vague intuitions of the designers due to the lack of studies on its relevance to the functionality and performance of the device. In this work, some criteria for designers are provided regarding the carpometacarpal joint of the thumb in these devices. To this end, we studied four prosthetic hands of similar characteristics with the motion of abduction/adduction of the thumb resolved in three different ways: fixed at a certain abduction, coupled with the motion of flexion/extension, and actuated independently of the flexion/extension. The functionality and performance of the hands were assessed for the basic grasps using the Anthropomorphic Hand Assessment Protocol (AHAP) and a reduced version of the Southampton Hand Assessment Procedure (SHAP). As a general rule, it seems desirable that thumb adduction/abduction is performed independently of flexion/extension, although this adds one degree of control. If having this additional degree of control is beyond debate, coupled flexion/extension and adduction/abduction should be avoided in favour of the thumb having a fixed slight palmar abduction.
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Park S, Lee J, Oh YE, Lee HJ, Jeon I, Kim K, Lee SJ. Improvements in hand functions and changes in proximal muscle activities in myoelectric prosthetic hand users at home: a case series. Prosthet Orthot Int 2022; 46:582-590. [PMID: 35511455 DOI: 10.1097/pxr.0000000000000139] [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: 06/02/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adaptation in proximal muscles for daily motor tasks after sustained use of a prosthetic hand has not been fully understood. OBJECTIVES This study aimed to investigate changes in hand functions and activities of proximal muscles after multiple weeks of using a myoelectric prosthetic hand at home. STUDY DESIGN Repeated measures. METHODS Four people with traumatic upper-limb loss used a myoelectric prosthetic hand (bebionic) at home over the 6- to 8-week period. A user survey, Orthotics and Prosthetics User Survey for Upper Extremity Functional Status 2.0, was used to measure upper-limb functions and the degree of using the prosthetic hand each week. Their hand functions, muscle activities, and grip-specific neuromuscular effort were evaluated by the Southampton Hand Assessment Procedure at the preassessment and postassessment sessions (PRE and POST, respectively). RESULTS All subjects increased Southampton Hand Assessment Procedure scores at PRE compared with POST with subject-specific changes in muscle activations. In a detail, at POST, subject 1 reduced the shoulder muscle activity compared with PRE, while at POST, subject 2 reduced biceps activity compared with PRE. At POST, greater pectoralis activity and reduced trapezius activity were observed in subject 3, and greater activity in those two muscles was found in subject 4 compared with PRE. CONCLUSION After multiple weeks of using the myoelectric prosthetic hands, their hand functions during ADL tasks were improved and changes in the muscle activities were found.
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Affiliation(s)
- Sangsoo Park
- Center for Bionics, Biomedical Research Institute, Korea Institute of Science and Technology, Korea I (UST), Seoul, South Korea
| | - Jaehyung Lee
- Center for Bionics, Biomedical Research Institute, Korea Institute of Science and Technology, Korea I (UST), Seoul, South Korea
| | - Ye Eun Oh
- Center for Human-centered Interaction for Coexistence, Seoul, South Korea
| | - Hyun-Joo Lee
- Kyungpook National University Hospital, Daegu, South Korea
| | - Inho Jeon
- Asan Medical Center, Seoul, South Korea
| | - Keehoon Kim
- Department of Mechanical Engineering, Postech, Pohang, South Korea
| | - Song Joo Lee
- Center for Bionics, Biomedical Research Institute, Korea Institute of Science and Technology, Korea I (UST), Seoul, South Korea
- The Division of Bio-Medical Science & Technology, KIST School, University of Science and Technology (UST), Seoul, South Korea
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Touillet A, Gouzien A, Badin M, Herbe P, Martinet N, Jarrassé N, Roby-Brami A. Kinematic analysis of impairments and compensatory motor behavior during prosthetic grasping in below-elbow amputees. PLoS One 2022; 17:e0277917. [PMID: 36399487 PMCID: PMC9674132 DOI: 10.1371/journal.pone.0277917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/06/2022] [Indexed: 11/19/2022] Open
Abstract
After a major upper limb amputation, the use of myoelectric prosthesis as assistive devices is possible. However, these prostheses remain quite difficult to control for grasping and manipulation of daily life objects. The aim of the present observational case study is to document the kinematics of grasping in a group of 10 below-elbow amputated patients fitted with a myoelectric prosthesis in order to describe and better understand their compensatory strategies. They performed a grasping to lift task toward 3 objects (a mug, a cylinder and a cone) placed at two distances within the reaching area in front of the patients. The kinematics of the trunk and upper-limb on the non-amputated and prosthetic sides were recorded with 3 electromagnetic Polhemus sensors placed on the hand, the forearm (or the corresponding site on the prosthesis) and the ipsilateral acromion. The 3D position of the elbow joint and the shoulder and elbow angles were calculated thanks to a preliminary calibration of the sensor position. We examined first the effect of side, distance and objects with non-parametric statistics. Prosthetic grasping was characterized by severe temporo-spatial impairments consistent with previous clinical or kinematic observations. The grasping phase was prolonged and the reaching and grasping components uncoupled. The 3D hand displacement was symmetrical in average, but with some differences according to the objects. Compensatory strategies involved the trunk and the proximal part of the upper-limb, as shown by a greater 3D displacement of the elbow for close target and a greater forward displacement of the acromion, particularly for far targets. The hand orientation at the time of grasping showed marked side differences with a more frontal azimuth, and a more "thumb-up" roll. The variation of hand orientation with the object on the prosthetic side, suggested that the lack of finger and wrist mobility imposed some adaptation of hand pose relative to the object. The detailed kinematic analysis allows more insight into the mechanisms of the compensatory strategies that could be due to both increased distal or proximal kinematic constraints. A better knowledge of those compensatory strategies is important for the prevention of musculoskeletal disorders and the development of innovative prosthetics.
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Affiliation(s)
- Amélie Touillet
- Louis Pierquin Centre of the Regional Institute of Rehabilitation, UGECAM Nord Est, Nancy, France
| | - Adrienne Gouzien
- Service de psychiatrie, Pôle Paris Centre, Hôpitaux de Saint-Maurice, Saint-Maurice, France
| | - Marina Badin
- Louis Pierquin Centre of the Regional Institute of Rehabilitation, UGECAM Nord Est, Nancy, France
| | - Pierrick Herbe
- Louis Pierquin Centre of the Regional Institute of Rehabilitation, UGECAM Nord Est, Nancy, France
| | - Noël Martinet
- Louis Pierquin Centre of the Regional Institute of Rehabilitation, UGECAM Nord Est, Nancy, France
| | - Nathanaël Jarrassé
- Institute of Intelligent Systems and Robotics (ISIR), UMR 7222, CNRS/INSERM, U1150 Agathe-ISIR, Sorbonne University, Paris, France
| | - Agnès Roby-Brami
- Institute of Intelligent Systems and Robotics (ISIR), UMR 7222, CNRS/INSERM, U1150 Agathe-ISIR, Sorbonne University, Paris, France
- * E-mail:
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Salminger S, Gstoettner C, Sturma A, Mayer JA, Papst H, Aszmann OC. Actual prosthetic usage in relation to functional outcomes and wearing time in individuals with below-elbow amputation. Prosthet Orthot Int 2022; 46:408-413. [PMID: 35511449 DOI: 10.1097/pxr.0000000000000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Wearing time of a prosthesis is regarded as an indicator for success of prosthetic rehabilitation. However, prostheses are frequently worn for esthetic purposes only. Although different supervised measurements to assess prosthetic dexterity are used, it is not clear how performance in such tests translates into actual use in everyday life. OBJECTIVES To evaluate the actual daily use of the prosthetic device in patients with below-elbow amputations by recording the number of grasping motions. STUDY DESIGN Observational study. METHODS Upper extremity function was evaluated using different objective and timed assessments in five unilateral patients with below-elbow amputations. In addition, patients reported daily wearing time, and the number of performed prosthetic movements over a period of at least three months was recorded. RESULTS The patients achieved a mean Southampton Hand Assessment Procedure score of 66.60 ± 18.64 points. The average blocks moved in the Box and Block Test were 20.80 ± 7.46, and the mean score in the Action Research Arm Test was 37.20 ± 5.45. The mean time for the Clothespin-Relocation Test was 26.90 ± 11.61 seconds. The patients reported a wearing time of an average of 12.80 ± 3.11 hours per day. The mean number of prosthetic motions performed each day was 257.23 ± 192.95 with a range from 23.07 to 489.13. CONCLUSIONS Neither high functionality nor long wearing times necessitated frequent use of a prosthesis in daily life. However, frequent daily motions did translate into good functional scores, indicating that regular device use in different real-life settings relates to functionality.
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Affiliation(s)
- Stefan Salminger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- 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
| | - Helmut Papst
- Otto Bock Healthcare Products GmbH, Vienna, Austria
| | - Oskar C Aszmann
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
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Parr JVV, Wright DJ, Uiga L, Marshall B, Mohamed MO, Wood G. A scoping review of the application of motor learning principles to optimize myoelectric prosthetic hand control. Prosthet Orthot Int 2022; 46:274-281. [PMID: 34932512 DOI: 10.1097/pxr.0000000000000083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
Although prosthetic hand rejection rates remain high, evidence suggests that effective training plays a major role in device acceptance. Receiving training early in the rehabilitation process also enhances functional prosthetic use, decreases the likelihood of developing an overreliance on the intact limb, and reduces amputation-related pain. Despite these obvious benefits, there is a current lack of evidence regarding the most effective training techniques to facilitate myoelectric prosthetic hand control, and it remains unknown whether training is effective in facilitating the acquisition and transfer of prosthetic skill. In this scoping review, we introduced and summarized key motor learning principles related to attentional focus, implicit motor learning, training eye-hand coordination, practice variability, motor imagery, and action observation, and virtual training and biofeedback. We then reviewed the existing literature that has applied these principles for training prosthetic hand control before outlining future avenues for further research. The importance of optimizing early and appropriate training cannot be overlooked. While the intuition and experience of clinicians holds enormous value, evidence-based guidelines based on well-established motor learning principles will also be crucial for training effective prosthetic hand control. While it is clear that more research is needed to form the basis of such guidelines, it is hoped that this review highlights the potential avenues for this work.
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Affiliation(s)
- Johnny V V Parr
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - David J Wright
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Health, Psychology and Communities, Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Liis Uiga
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Ben Marshall
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Mohamed Omar Mohamed
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Greg Wood
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester UK
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
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Preliminary Evaluation of the Effect of Mechanotactile Feedback Location on Myoelectric Prosthesis Performance Using a Sensorized Prosthetic Hand. SENSORS 2022; 22:s22103892. [PMID: 35632311 PMCID: PMC9145984 DOI: 10.3390/s22103892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023]
Abstract
A commonly cited reason for the high abandonment rate of myoelectric prostheses is a lack of grip force sensory feedback. Researchers have attempted to restore grip force sensory feedback by stimulating the residual limb’s skin surface in response to the prosthetic hand’s measured grip force. Recent work has focused on restoring natural feedback to the missing digits directly through invasive surgical procedures. However, the functional benefit of utilizing somatotopically matching feedback has not been evaluated. In this paper, we propose an experimental protocol centered on a fragile object grasp and lift task using a sensorized myoelectric prosthesis to evaluate sensory feedback techniques. We formalized a suite of outcome measures related to task success, timing, and strategy. A pilot study (n = 3) evaluating the effect of utilizing a somatotopically accurate feedback stimulation location in able-bodied participants was conducted to evaluate the feasibility of the standardized platform, and to inform future studies on the role of feedback stimulation location in prosthesis use. Large between-participant effect sizes were observed in all outcome measures, indicating that the feedback location likely plays a role in myoelectric prosthesis performance. The success rate decreased, and task timing and task focus metrics increased, when using somatotopically-matched feedback compared to non-somatotopically-matched feedback. These results were used to conduct a power analysis, revealing that a sample size of n = 8 would be sufficient to achieve significance in all outcome measures.
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Sinke M, Chadwell A, Smit G. State of the art of prosthesis simulators for the upper limb: A narrative review. Ann Phys Rehabil Med 2022; 65:101635. [PMID: 35091112 DOI: 10.1016/j.rehab.2022.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Research into prosthesis training and design puts a burden on the small population of people with upper-limb absence who can participate in these studies. One solution is to use a prosthetic hand simulator, which allows for attaching a hand prosthesis to an intact limb. However, whether the results of prosthesis simulator studies can be translated to people with upper-limb absence using a hand prosthesis is unclear. OBJECTIVE To review the literature on prosthetic hand simulators, provide an overview of current designs, and highlight the differences and similarities between prosthesis simulators and traditional prostheses. METHODS A Boolean combination of keywords was used to search 3 electronic databases: PubMed, Scopus and Web of Science. Relevant articles in English were selected. RESULTS In total, 52 papers were included in the review, and an overview of the state of the art was presented. We identified the key differences between prosthesis simulators and traditional prostheses as the position of the terminal device and the available degrees of freedom of the arm and (prosthetic) wrist. CONCLUSIONS This paper provides an overview of prosthesis simulator designs over the past 27 years and an overview of the similarities and differences between prosthesis simulators and prostheses. The literature does not provide enough evidence to establish whether the results obtained from simulator studies could be translated to prostheses. A recommendation for future simulator design is to constrain pro- and supination of the forearm of anatomically intact participants and add a prosthetic wrist that can pro- and supinate. Additional research is required to find the ideal terminal device position for a prosthesis simulator with respect to the person's hand.
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Affiliation(s)
- Maaike Sinke
- BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Alix Chadwell
- Health Sciences Research Centre, University of Salford, Salford, M6 6PU, UK
| | - Gerwin Smit
- BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
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Liu Y, Caracoglia J, Sen S, Freud E, Striem-Amit E. Are reaching and grasping effector-independent? Similarities and differences in reaching and grasping kinematics between the hand and foot. Exp Brain Res 2022; 240:1833-1848. [PMID: 35426511 PMCID: PMC9142431 DOI: 10.1007/s00221-022-06359-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Abstract
While reaching and grasping are highly prevalent manual actions, neuroimaging studies provide evidence that their neural representations may be shared between different body parts, i.e., effectors. If these actions are guided by effector-independent mechanisms, similar kinematics should be observed when the action is performed by the hand or by a cortically remote and less experienced effector, such as the foot. We tested this hypothesis with two characteristic components of action: the initial ballistic stage of reaching, and the preshaping of the digits during grasping based on object size. We examined if these kinematic features reflect effector-independent mechanisms by asking participants to reach toward and to grasp objects of different widths with their hand and foot. First, during both reaching and grasping, the velocity profile up to peak velocity matched between the hand and the foot, indicating a shared ballistic acceleration phase. Second, maximum grip aperture and time of maximum grip aperture of grasping increased with object size for both effectors, indicating encoding of object size during transport. Differences between the hand and foot were found in the deceleration phase and time of maximum grip aperture, likely due to biomechanical differences and the participants’ inexperience with foot actions. These findings provide evidence for effector-independent visuomotor mechanisms of reaching and grasping that generalize across body parts.
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Affiliation(s)
- Yuqi Liu
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, 20057, USA.
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Sciences and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
| | - James Caracoglia
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, 20057, USA
- Division of Graduate Medical Sciences, Boston University Medical Center, Boston, MA, 02215, USA
| | - Sriparna Sen
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, 20057, USA
| | - Erez Freud
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada
- Centre for Vision Research, York University, Toronto, ON, M3J 1P3, Canada
| | - Ella Striem-Amit
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, 20057, USA.
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Comparison of Motion Analysis Systems in Tracking Upper Body Movement of Myoelectric Bypass Prosthesis Users. SENSORS 2022; 22:s22082953. [PMID: 35458943 PMCID: PMC9029489 DOI: 10.3390/s22082953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 02/01/2023]
Abstract
Current literature lacks a comparative analysis of different motion capture systems for tracking upper limb (UL) movement as individuals perform standard tasks. To better understand the performance of various motion capture systems in quantifying UL movement in the prosthesis user population, this study compares joint angles derived from three systems that vary in cost and motion capture mechanisms: a marker-based system (Vicon), an inertial measurement unit system (Xsens), and a markerless system (Kinect). Ten healthy participants (5F/5M; 29.6 ± 7.1 years) were trained with a TouchBionic i-Limb Ultra myoelectric terminal device mounted on a bypass prosthetic device. Participants were simultaneously recorded with all systems as they performed standardized tasks. Root mean square error and bias values for degrees of freedom in the right elbow, shoulder, neck, and torso were calculated. The IMU system yielded more accurate kinematics for shoulder, neck, and torso angles while the markerless system performed better for the elbow angles. By evaluating the ability of each system to capture kinematic changes of simulated upper limb prosthesis users during a variety of standardized tasks, this study provides insight into the advantages and limitations of using different motion capture technologies for upper limb functional assessment.
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Olsen J, Head J, Willan L, Dupan S, Dyson M. Remote creation of clinical-standard myoelectric trans-radial bypass sockets during COVID-19. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6500-6503. [PMID: 34892599 DOI: 10.1109/embc46164.2021.9630925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To enable the progression of research during the COVID-19 lockdown, a novel remote method of creating clinical standard trans-radial bypass sockets was devised as a collaboration between an engineering team and a clinical research group. The engineering team recruited two able-bodied participants, marked areas of interest on the participant's limb and captured limb geometry and electrode sites with a high definition optical scanner. The resulting 3D scan was modified to make electrode sites and areas of interest recessed and tactile. Models were 3D printed to scale and posted to the clinical team to manufacture the sockets. A modified lamination process was used, comprising plaster casting and rectifiying the model by hand. The recessed areas of the 3D printed model were used to guide the process. The bypass sockets were returned to the engineering team for testing. A simple electromyography (EMG) tracking task was performed using clinical electrodes to validate the skin-electrode contact and alignment. This paper demonstrates a validated method for remotely creating transradial bypass sockets. There is potential to extrapolate this method to standard socket fittings with further research.
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Dyson M, Olsen J, Dupan S. A Network-Enabled Myoelectric Platform for Prototyping Research Outside of the Lab. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7422-7425. [PMID: 34892812 DOI: 10.1109/embc46164.2021.9630318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present a network-enabled myoelectric platform for performing research outside of the laboratory environment. A low-cost, flexible, modular design based on common Internet of Things connectivity technology allows home-based research to be piloted. An outline of the platform is presented followed by technical results obtained from ten days of home-based tests with three participants. Results show the system enabled collection of close to 12,000 trials during around 28 cumulative hours of use. Home-based testing of multiple participants in parallel offers efficiency gains and provides a intuitive route toward long-term testing of upper-limb prosthetic devices in more naturalistic settings.Clinical relevance- In-home myoelectric training reduces clinician time. Network-enabled systems with back-end dashboards allow clinicians to monitor patients myoelectric ability over time and will provide a new way of accessing information about how upper-limb prosthetics are commonly used.
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Widehammar C, Lidström Holmqvist K, Hermansson L. Training for users of myoelectric multigrip hand prostheses: a scoping review. Prosthet Orthot Int 2021; 45:393-400. [PMID: 34456321 DOI: 10.1097/pxr.0000000000000037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Training is crucial to develop the ability to operate a myoelectric prosthetic hand and use it in daily life. Multigrip prostheses, with their wider repertoire of functions, require further training. Because studies show that prosthesis abandonment is an issue and the advanced functions are not used to the expected extent, the question of what training should be offered to patients arises. If the available training methods were synthesized, the training could be improved to the benefit of the people who are fitted with a multigrip prosthesis. OBJECTIVE To critically examine the content of published sources for training of users with myoelectric multigrip hand prostheses. STUDY DESIGN Scoping review. METHODS A literature search covering the period 2007-2020 in the databases PubMed, CINAHL, and Allied and Complementary Medicine Database, as well as gray literature from prosthesis manufacturers, identified 2,005 sources. After full-text review of 88 articles and four user manuals from manufacturers, nine sources were included and analyzed in their entirety. RESULTS We found few descriptions of multigrip prosthesis training, and no source described all training phases in detail. Integration of the prosthesis and training in daily activities was described least. Few sources actually described how to perform training in multigrip functions, and none described how to integrate these functions in daily life. CONCLUSIONS Existing training instructions for using multigrip prosthetic hands are inadequate, providing poor guidance to clinicians and insufficient training for patients. Further research is needed into the efficiency of various training methods.
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Affiliation(s)
- Cathrine Widehammar
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kajsa Lidström Holmqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Liselotte Hermansson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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18
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Heerschop A, van der Sluis CK, Bongers RM. Transfer of mode switching performance: from training to upper-limb prosthesis use. J Neuroeng Rehabil 2021; 18:85. [PMID: 34022945 PMCID: PMC8141154 DOI: 10.1186/s12984-021-00878-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current myoelectric prostheses are multi-articulated and offer multiple modes. Switching between modes is often done through pre-defined myosignals, so-called triggers, of which the training hardly is studied. We evaluated if switching skills trained without using a prosthesis transfer to actual prosthesis use and whether the available feedback during training influences this transfer. Furthermore we examined which clinically relevant performance measures and which myosignal features were adapted during training. METHODS Two experimental groups and one control group participated in a five day pre-test-post-test design study. Both experimental groups used their myosignals to perform a task. One group performed a serious game without seeing their myosignals, the second group was presented their myosignal on a screen. The control group played the serious game using the touchpad of the laptop. Each training session lasted 15 min. The pre- and post-test were identical for all groups and consisted of performing a task with an actual prosthesis, where switches had to be produced to change grip mode to relocate clothespins. Both clinically relevant performance measures and myosignal features were analysed. RESULTS 10 participants trained using the serious game, 10 participants trained with the visual myosignal and 8 the control task. All participants were unimpaired. Both experimental groups showed significant transfer of skill from training to prosthesis use, the control group did not. The degree of transfer did not differ between the two training groups. Clinically relevant measure 'accuracy' and feature of the myosignals 'variation in phasing' changed during training. CONCLUSIONS Training switching skills appeared to be successful. The skills trained in the game transferred to performance in a functional task. Learning switching skills is independent of the type of feedback used during training. Outcome measures hardly changed during training and further research is needed to explain this. It should be noted that five training sessions did not result in a level of performance needed for actual prosthesis use. Trial registration The study was approved by the local ethics committee (ECB 2014.02.28_1) and was included in the Dutch trial registry (NTR5876).
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Affiliation(s)
- Anniek Heerschop
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corry K. van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Raoul M. Bongers
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Williams HE, Chapman CS, Pilarski PM, Vette AH, Hebert JS. Myoelectric prosthesis users and non-disabled individuals wearing a simulated prosthesis exhibit similar compensatory movement strategies. J Neuroeng Rehabil 2021; 18:72. [PMID: 33933105 PMCID: PMC8088043 DOI: 10.1186/s12984-021-00855-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background Research studies on upper limb prosthesis function often rely on the use of simulated myoelectric prostheses (attached to and operated by individuals with intact limbs), primarily to increase participant sample size. However, it is not known if these devices elicit the same movement strategies as myoelectric prostheses (operated by individuals with amputation). The objective of this study was to address the question of whether non-disabled individuals using simulated prostheses employ the same compensatory movements (measured by hand and upper body kinematics) as individuals who use actual myoelectric prostheses. Methods The upper limb movements of two participant groups were investigated: (1) twelve non-disabled individuals wearing a simulated prosthesis, and (2) three individuals with transradial amputation using their custom-fitted myoelectric devices. Motion capture was used for data collection while participants performed a standardized functional task. Performance metrics, hand movements, and upper body angular kinematics were calculated. For each participant group, these measures were compared to those from a normative baseline dataset. Each deviation from normative movement behaviour, by either participant group, indicated that compensatory movements were used during task performance. Results Results show that participants using either a simulated or actual myoelectric prosthesis exhibited similar deviations from normative behaviour in phase durations, hand velocities, hand trajectories, number of movement units, grip aperture plateaus, and trunk and shoulder ranges of motion. Conclusions This study suggests that the use of a simulated prosthetic device in upper limb research offers a reasonable approximation of compensatory movements employed by a low- to moderately-skilled transradial myoelectric prosthesis user.
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Affiliation(s)
- Heather E Williams
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Craig S Chapman
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Patrick M Pilarski
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Albert H Vette
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada.,Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Jacqueline S Hebert
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
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20
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Wang SL, Bloomer C, Civillico G, Kontson K. Application of machine learning to the identification of joint degrees of freedom involved in abnormal movement during upper limb prosthesis use. PLoS One 2021; 16:e0246795. [PMID: 33571311 PMCID: PMC7877744 DOI: 10.1371/journal.pone.0246795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
To evaluate movement quality of upper limb (UL) prosthesis users, performance-based outcome measures have been developed that examine the normalcy of movement as compared to a person with a sound, intact hand. However, the broad definition of “normal movement” and the subjective nature of scoring can make it difficult to know which areas of the body to evaluate, and the expected magnitude of deviation from normative movement. To provide a more robust approach to characterizing movement differences, the goals of this work are to identify degrees of freedom (DOFs) that will inform abnormal movement for several tasks using unsupervised machine learning (clustering methods) and elucidate the variations in movement approach across two upper-limb prosthesis devices with varying DOFs as compared to healthy controls. 24 participants with no UL disability or impairment were recruited for this study and trained on the use of a body-powered bypass (n = 6) or the DEKA limb bypass (n = 6) prosthetic devices or included as normative controls. 3D motion capture data were collected from all participants as they performed the Jebsen-Taylor Hand Function Test (JHFT) and targeted Box and Blocks Test (tBBT). Range of Motion, peak angle, angular path length, mean angle, peak angular velocity, and number of zero crossings were calculated from joint angle data for the right/left elbows, right/left shoulders, torso, and neck and fed into a K-means clustering algorithm. Results show right shoulder and torso DOFs to be most informative in distinguishing between bypass user and norm group movement. The JHFT page turning task and the seated tBBT elicit movements from bypass users that are most distinctive from the norm group. Results can be used to inform the development of movement quality scoring methodology for UL performance-based outcome measures. Identifying tasks across two different devices with known variations in movement can inform the best tasks to perform in a rehabilitation setting that challenge the prosthesis user’s ability to achieve normative movement.
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Affiliation(s)
- Sophie L. Wang
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
- Department of Bioengineering, University of Maryland, College Park, Maryland, United States of America
| | - Conor Bloomer
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Gene Civillico
- Office of the National Institutes of Health Director, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Kimberly Kontson
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail:
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21
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Kristoffersen MB, Franzke AW, van der Sluis CK, Murgia A, Bongers RM. Serious gaming to generate separated and consistent EMG patterns in pattern-recognition prosthesis control. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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22
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Llop-Harillo I, Pérez-González A, Andrés-Esperanza J. Grasping Ability and Motion Synergies in Affordable Tendon-Driven Prosthetic Hands Controlled by Able-Bodied Subjects. Front Neurorobot 2020; 14:57. [PMID: 32982713 PMCID: PMC7480172 DOI: 10.3389/fnbot.2020.00057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022] Open
Abstract
Affordable 3D-printed tendon-driven prosthetic hands are a rising trend because of their availability and easy customization. Nevertheless, comparative studies about the functionality of this kind of prostheses are lacking. The tradeoff between the number of actuators and the grasping ability of prosthetic hands is a relevant issue in their design. The analysis of synergies among fingers is a common method used to reduce dimensionality without any significant loss of dexterity. Therefore, the purpose of this study is to assess the functionality and motion synergies of different tendon-driven hands using an able-bodied adaptor. The use of this adaptor to control the hands by means of the fingers of healthy subjects makes it possible to take advantage of the human brain control while obtaining the synergies directly from the artificial hand. Four artificial hands (IMMA, Limbitless, Dextrus v2.0, InMoov) were confronted with the Anthropomorphic Hand Assessment Protocol, quantifying functionality and human-like grasping. Three subjects performed the tests by means of a specially designed able-bodied adaptor that allows each tendon to be controlled by a different human finger. The tendon motions were registered, and correlation and principal component analyses were used to obtain the motion synergies. The grasping ability of the analyzed hands ranged between 48 and 57% with respect to that of the human hand, with the IMMA hand obtaining the highest score. The effect of the subject on the grasping ability score was found to be non-significant. For all the hands, the highest tendon-pair synergies were obtained for pairs of long fingers and were greater for adjacent fingers. The principal component analysis showed that, for all the hands, two principal components explained close to or more than 80% of the variance. Several factors, such as the friction coefficient of the hand contact surfaces, limitations on the underactuation, and impairments for a correct thumb opposition need to be improved in this type of prostheses to increase their grasping stability. The principal components obtained in this study provide useful information for the design of transmission or control systems to underactuate these hands.
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Affiliation(s)
- Immaculada Llop-Harillo
- Grupo de Biomecánica y Ergonomía, Departamento de Ingeniería Mecánica y Construcción, Universitat Jaume I (UJI), Castelló de la Plana, Spain
| | - Antonio Pérez-González
- Grupo de Biomecánica y Ergonomía, Departamento de Ingeniería Mecánica y Construcción, Universitat Jaume I (UJI), Castelló de la Plana, Spain
| | - Javier Andrés-Esperanza
- Grupo de Biomecánica y Ergonomía, Departamento de Ingeniería Mecánica y Construcción, Universitat Jaume I (UJI), Castelló de la Plana, Spain
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Yoshimura M, Kurumadani H, Hirata J, Osaka H, Senoo K, Date S, Ueda A, Ishii Y, Kinoshita S, Hanayama K, Sunagawa T. Virtual reality-based action observation facilitates the acquisition of body-powered prosthetic control skills. J Neuroeng Rehabil 2020; 17:113. [PMID: 32819412 PMCID: PMC7439659 DOI: 10.1186/s12984-020-00743-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022] Open
Abstract
Background Regular body-powered (BP) prosthesis training facilitates the acquisition of skills through repeated practice but requires adequate time and motivation. Therefore, auxiliary tools such as indirect training may improve the training experience and speed of skill acquisition. In this study, we examined the effects of action observation (AO) using virtual reality (VR) as an auxiliary tool. We used two modalities during AO: three-dimensional (3D) VR and two-dimensional (2D) computer tablet devices (Tablet). Each modality was tested from first- and third-person perspectives. Methods We studied 40 healthy right-handed participants wearing a BP prosthesis simulator on their non-dominant hands. The participants were divided into five groups based on combinations of the different modalities and perspectives: first-person perspective on VR (VR1), third-person perspective on VR (VR3), first-person perspective on a tablet (Tablet1), third-person perspective on a tablet (Tablet3), and a control group (Control). The intervention groups observed and imitated the video image of prosthesis operation for 10 min in each of two sessions. We evaluated the level of immersion during AO using the visual analogue scale. Prosthetic control skills were evaluated using the Box and Block Test (BBT) and a bowknot task (BKT). Results In the BBT, there were no significant differences in the amount of change in the skills between the five groups. In contrast, the relative changes in the BKT prosthetic control skills in VR1 (p < 0.001, d = 3.09) and VR3 (p < 0.001, d = 2.16) were significantly higher than those in the control group. Additionally, the immersion scores of VR1 (p < 0.05, d = 1.45) and VR3 (p < 0.05, d = 1.18) were higher than those of Tablet3. There was a significant negative correlation between the immersion scores and the relative change in the BKT scores (Spearman’s rs = − 0.47, p < 0.01). Conclusions Using the BKT of bilateral manual dexterity, VR-based AO significantly improved short-term prosthetic control acquisition. Additionally, it appeared that the higher the immersion score was, the shorter the execution time of the BKT task. Our findings suggest that VR-based AO training may be effective in acquiring bilateral BP prosthetic control, which requires more 3D-based operation.
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Affiliation(s)
- Manabu Yoshimura
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan. .,Kawasaki University of Medical Welfare, Okayama, Japan, 288 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Hiroshi Kurumadani
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Junya Hirata
- Kawasaki University of Medical Welfare, Okayama, Japan, 288 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Hiroshi Osaka
- Kawasaki University of Medical Welfare, Okayama, Japan, 288 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Katsutoshi Senoo
- Kawasaki University of Medical Welfare, Okayama, Japan, 288 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Shota Date
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Akio Ueda
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yosuke Ishii
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Seiji Kinoshita
- Kawasaki Medical School Hospital, Okayama, Japan, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kozo Hanayama
- Kawasaki Medical School, Department of Rehabilitation Medicine, Okayama, Japan, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Toru Sunagawa
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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24
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Learning, Generalization, and Scalability of Abstract Myoelectric Control. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1539-1547. [DOI: 10.1109/tnsre.2020.3000310] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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25
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Bloomer C, Kontson KL. Comparison of DEKA Arm and Body-Powered Upper Limb Prosthesis Joint Kinematics. Arch Rehabil Res Clin Transl 2020; 2:100057. [PMID: 33543084 PMCID: PMC7853360 DOI: 10.1016/j.arrct.2020.100057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives To study the effects of advancements in upper-limb prosthesis technology on the user through biomechanical analyses at the joint level to quantitatively examine movement differences of individuals using an advanced upper-limb device, the DEKA Arm, and a conventional device, a body-powered Hosmer hook. Design Clinical measurement. Setting Laboratories at the United States Food and Drug Administration. Participants Convenience sample of participants (N=14) with no upper limb disability or impairment. Interventions All participants were trained on either an upper limb body-powered (n=6) or DEKA Arm (n=8) bypass device. Main Outcome Measures Participants completed the Jebsen-Taylor Hand Function Test (JHFT) and targeted Box and Blocks Test within a motion capture framework. Task completion times and joint angle trajectories for each degree of freedom of the right elbow, right shoulder, and torso were collected and analyzed for range of motion, mean angle, maximum angle, and angle path length during each task. Results Significant differences between devices were observed across metrics in at least one task for each degree of freedom. Completion times were significantly higher for DEKA users (eg, 30.51±19.29s vs 9.30±1.44s) for JHFT-simulated feeding. Some kinematic measures, such as angle path length, were significantly lower in DEKA users, with the greatest difference in the right elbow flexion path length during JHFT-Page Turning (0.29±0.14 units vs 0.11±0.04 units). Conclusions Results from this work elucidate the effect of the device on the user's movement approach and performance, as well as emphasizing the importance of capturing movement quality into the assessment of function for advanced prosthetic technology to fully understand and evaluate potential benefits.
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Affiliation(s)
| | - Kimberly L. Kontson
- Corresponding author Kimberly L. Kontson, PhD, 10903 New Hampshire Ave, Silver Spring, MD 20993.
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Itaguchi Y. Toward natural grasping with a tool: effects of practice and required accuracy on the kinematics of tool-use grasping. J Neurophysiol 2020; 123:2024-2036. [PMID: 32319844 DOI: 10.1152/jn.00384.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Studies have suggested that the proficiency of an end effector is the primary factor that defines kinematics of reach-to-grasp movements across the types of effectors, such as the hand or a tool. In particular, the duration of the plateau, or the time of static open aperture (i.e., the distance between tips of effectors), is typically longer for tool use compared with natural grasping with a hand. This study investigated how improvement in the proficiency of tool use modifies the kinematics of reach-to-grasp movements. To clarify the effects of required accuracy on the kinematics in tool-use grasping, movement speed and difficulty of grasping were manipulated. The results showed that plateau duration, the length of which indicates that reaching and grasping components are temporally dissociated, shortened as tool-use practice proceeded. These results indirectly support the idea that shortened plateau duration was induced by improvement in the proficiency of tool use. Moreover, plateau duration was shortened at faster movement speeds or under conditions not requiring accurate grasping, even without any practice of tool-use grasping. Additional analyses found that plateau duration did not scale with movement time. These results suggest that the kinematic features supposed to be characteristic of tool-use grasping are not inevitable but are greatly influenced by a strategy that is not intentionally but rather automatically implemented to compensate for the lack of proficiency of end effectors, in agreement with the idea that the brain focuses on the tips of an end effector regardless of its effector type in reach-to-grasp movements.NEW & NOTEWORTHY This study is the first reporting the relation between characteristic aperture time profile, called plateau duration, and movement time of tool-use grasping. The results suggest that improved coordination between reaching and grasping components was induced by improvement in the proficiency of tool use but not by just shortened movement time. The results also indicate the possibility that the constraints for calculations in motor planning are essentially the same between hand-use grasping and tool-use grasping.
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Affiliation(s)
- Yoshihiro Itaguchi
- Department of Computer Science, Shizuoka University, Hamamatsu, Japan.,Department of Psychology, Waseda University, Tokyo, Japan
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Heerschop A, van der Sluis CK, Otten E, Bongers RM. Performance among different types of myocontrolled tasks is not related. Hum Mov Sci 2020; 70:102592. [PMID: 32217210 DOI: 10.1016/j.humov.2020.102592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/23/2019] [Accepted: 02/08/2020] [Indexed: 01/08/2023]
Abstract
Studies on myocontrolled assistive technology (AT), such as myoelectric prostheses, as well as rehabilitation practice using myoelectric controlled interfaces, commonly assume the existence of a general myocontrol skill. This is the skill to control myosignals in such a way that they are employable in multiple tasks. If this skill exists, training any myocontrolled task using a certain set of muscles would improve the use of myocontrolled AT when the AT is controlled using these muscles. We examined whether a general myocontrol skill exists in myocontrolled tasks with and without a prosthesis. Unimpaired, right-handed adults used the sEMG of wrist flexors and extensors to perform several tasks in two experiments. In Experiment 1, twelve participants trained a myoelectric prosthesis-simulator task and a myocontrolled serious game for five consecutive days. Performance was compared between tasks and over the course of the training period. In Experiment 2, thirty-one participants performed five myocontrolled tasks consisting of two serious games, two prosthesis-simulator tasks and one digital signal matching task. All tasks were based on tasks currently used in clinical practice or research settings. Kendall rank correlation coefficients were computed to analyze correlations between the performance on different tasks. In Experiment 1 performance on the tasks showed no correlation for multiple outcome measures. Rankings within tasks did not change over the training period. In Experiment 2 performance did not correlate between any of the tasks. Since performance between different tasks did not correlate, results suggest that a general myocontrol skill does not exist and that each myocontrolled task requires a specific skill. Generalization of those findings to amputees using AT should be done with caution since in both experiments unimpaired participants were included. Moreover, training duration in Experiment 2 was short. Our findings indicate that training and assessment methods for myocontrolled AT use should focus on tasks frequently performed in daily life by the individual using the AT instead of merely focusing on training myosignals.
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Affiliation(s)
- Anniek Heerschop
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands.
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands.
| | - Egbert Otten
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands.
| | - Raoul M Bongers
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands.
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Bloomer C, Wang S, Kontson K. Kinematic analysis of motor learning in upper limb body-powered bypass prosthesis training. PLoS One 2020; 15:e0226563. [PMID: 31978051 PMCID: PMC6980621 DOI: 10.1371/journal.pone.0226563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/28/2019] [Indexed: 12/03/2022] Open
Abstract
Motor learning and compensatory movement are important aspects of prosthesis training yet relatively little quantitative evidence supports our current understanding of how motor control and compensation develop in the novel body-powered prosthesis user. The goal of this study is to assess these aspects of prosthesis training through functional, kinematic, and kinetic analyses using a within-subject paradigm compared across two training time points. The joints evaluated include the left and right shoulders, torso, and right elbow. Six abled-bodied subjects (age 27 ± 3) using a body-powered bypass prosthesis completed the Jebsen-Taylor Hand Function Test and the targeted Box and Blocks Test after five training sessions and again after ten sessions. Significant differences in movement parameters included reduced times to complete tasks, reduced normalized jerk for most joints and tasks, and more variable changes in efficiency and compensation parameters for individual tasks and joints measured as range of motion, maximum angle, and average moment. Normalized jerk, joint specific path length, range of motion, maximum angle, and average moment are presented for the first time in this unique training context and for this specific device type. These findings quantitatively describe numerous aspects of motor learning and control in able-bodied subjects that may be useful in guiding future rehabilitation and training of body-powered prosthesis users.
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Affiliation(s)
- Conor Bloomer
- Division of Biomedical Physics, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Sophie Wang
- Division of Biomedical Physics, Food and Drug Administration, Silver Spring, Maryland, United States of America
- Department of Bioengineering, University of Maryland, College Park, Maryland, United States of America
| | - Kimberly Kontson
- Division of Biomedical Physics, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail:
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Heerschop A, van der Sluis CK, Otten E, Bongers RM. Looking beyond proportional control: The relevance of mode switching in learning to operate multi-articulating myoelectric upper-limb prostheses. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Parr JVV, Vine SJ, Wilson MR, Harrison NR, Wood G. Visual attention, EEG alpha power and T7-Fz connectivity are implicated in prosthetic hand control and can be optimized through gaze training. J Neuroeng Rehabil 2019; 16:52. [PMID: 31029174 PMCID: PMC6487034 DOI: 10.1186/s12984-019-0524-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/16/2019] [Indexed: 01/29/2023] Open
Abstract
Background Prosthetic hands impose a high cognitive burden on the user that often results in fatigue, frustration and prosthesis rejection. However, efforts to directly measure this burden are sparse and little is known about the mechanisms behind it. There is also a lack of evidence-based training interventions designed to improve prosthesis hand control and reduce the mental effort required to use them. In two experiments, we provide the first direct evaluation of this cognitive burden using measurements of EEG and eye-tracking (Experiment 1), and then explore how a novel visuomotor intervention (gaze training; GT) might alleviate it (Experiment 2). Methods In Experiment 1, able-bodied participants (n = 20) lifted and moved a jar, first using their anatomical hand and then using a myoelectric prosthetic hand simulator. In experiment 2, a GT group (n = 12) and a movement training (MT) group (n = 12) trained with the prosthetic hand simulator over three one hour sessions in a picking up coins task, before returning for retention, delayed retention and transfer tests. The GT group received instruction regarding how to use their eyes effectively, while the MT group received movement-related instruction typical in rehabilitation. Results Experiment 1 revealed that when using the prosthetic hand, participants performed worse, exhibited spatial and temporal disruptions to visual attention, and exhibited a global decrease in EEG alpha power (8-12 Hz), suggesting increased cognitive effort. Experiment 2 showed that GT was the more effective method for expediting prosthesis learning, optimising visual attention, and lowering conscious control – as indexed by reduced T7-Fz connectivity. Whilst the MT group improved performance, they did not reduce hand-focused visual attention and showed increased conscious movement control. The superior benefits of GT transferred to a more complex tea-making task. Conclusions These experiments quantify the visual and cortical mechanisms relating to the cognitive burden experienced during prosthetic hand control. They also evidence the efficacy of a GT intervention that alleviated this burden and promoted better learning and transfer, compared to typical rehabilitation instructions. These findings have theoretical and practical implications for prosthesis rehabilitation, the development of emerging prosthesis technologies and for the general understanding of human-tool interactions. Electronic supplementary material The online version of this article (10.1186/s12984-019-0524-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J V V Parr
- School of Health Sciences, Liverpool Hope University, Liverpool, UK
| | - S J Vine
- College of Life & Environmental Sciences, University of Exeter, Exeter, UK
| | - M R Wilson
- College of Life & Environmental Sciences, University of Exeter, Exeter, UK
| | - N R Harrison
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - G Wood
- Research Centre for Musculoskeletal Science and Sports Medicine Department of Sport and Exercise Science, Manchester Metropolitan University, Manchester, UK.
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Fu Q, Shao F, Santello M. Inter-Limb Transfer of Grasp Force Perception With Closed-Loop Hand Prosthesis. IEEE Trans Neural Syst Rehabil Eng 2019; 27:927-936. [PMID: 31021799 DOI: 10.1109/tnsre.2019.2911893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Sensory feedback of grasp forces provides important information about physical interactions between the hand and objects, enabling both reactive and anticipatory neural control mechanisms. The numerous studies have shown artificial sensory feedback of various forms improves force control during grasping tasks by prosthetic hand users through a closed-feedback loop. However, little is known about how perceptual information is transferred between an intact limb and a closed-loop prosthetic limb, and the extent to which training inter-limb transfer may improve myoelectric prosthetic control. We addressed these gaps by using a contralateral force-matching task in which able-bodied participants were asked to generate grasp forces with their native hand, and then match it using the contralateral hand or a soft-synergy prosthetic hand worn on the contralateral arm that was coupled with a mechanotactile feedback device. We found that absolute matching error and matching time were greater when using the prosthetic system than the native hand. However, with contralateral specific training, subjects were able to produce similar relative matching error with the prosthetic system and the native hand, especially at the untrained force level. These findings suggest that an association can be established between the perception produced by the prosthetic limb and the contralateral intact limb, and provide novel insights about potential applications to training and design of the closed-loop prosthesis.
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Romkema S, Bongers RM, van der Sluis CK. Influence of mirror therapy and motor imagery on intermanual transfer effects in upper-limb prosthesis training of healthy participants: A randomized pre-posttest study. PLoS One 2018; 13:e0204839. [PMID: 30300378 PMCID: PMC6177130 DOI: 10.1371/journal.pone.0204839] [Citation(s) in RCA: 6] [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: 01/14/2018] [Accepted: 09/13/2018] [Indexed: 12/13/2022] Open
Abstract
The effect that a motor skill trained on one side can lead to improvement in the untrained side is called intermanual transfer. Intermanual transfer can help enhance upper limb prosthetic training. To determine the influence of mirror therapy and motor imagery on intermanual transfer in upper limb prosthesis training, a pseudo-randomized clinical trial, single blinded, with a pre-posttest design was used. Forty-seven able-bodied, right-handed participants were pseudo-randomly assigned to two training groups and one control group. One training group undertook an intermanual transfer training program, using an upper-limb prosthetic simulator with added mirror therapy and motor imagery. The second training group completed only the intermanual transfer training program. The control group completed a sham training: a dummy training without using the prosthesis simulator. The program lasted five consecutive days. To determine the improvement in skill, a test was administered before, immediately after, and six days after the training program. Training used the "unaffected" arm; tests were performed with the "affected" arm, resembling the amputated limb. Movement time, the time from the beginning of the movement until completion of the task; hand opening, the duration of the maximum prosthetic hand opening; and grip-force control, the deviation from the required force during a tracking task. No intermanual transfer effects were found: neither the intermanual transfer training program, nor the additional mirror therapy and motor imagery affected prosthesis skills. A limitation of the study was that the training program was applied to able-bodied subjects instead of patients with an amputation. Contrary to previous studies, no intermanual transfer effects were found. Additional mirror therapy and motor imagery did not ameliorate intermanual transfer effects.
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Affiliation(s)
- Sietske Romkema
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
- * E-mail:
| | - Raoul M. Bongers
- University of Groningen, University Medical Center Groningen, Center of Human Movement Sciences, Groningen, the Netherlands
| | - Corry K. van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
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Bloomer C, Wang S, Kontson K. Creating a standardized, quantitative training protocol for upper limb bypass prostheses. PHYSICAL MEDICINE AND REHABILITATION RESEARCH 2018; 3:1-8. [PMID: 31172033 PMCID: PMC6547834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We aim to present a standard protocol for training able-bodied individuals to use a body-powered bypass prosthesis and assess training length and impact of prepositioning. The protocol design and subsequent analysis aims to facilitate controlled and efficient implementation of the able-bodied bypass user in the research setting. Six volunteers completed ten two-hour sessions with a body-powered bypass prosthesis. Each session included standardized training tasks: object manipulation, free training, and activities of daily living. Two outcome measures, a modified Southampton Hand Assessment Procedure and the Box and Blocks Test were used to score performance during each session. A standard learning curve was fitted to the scores to determine an optimal training length based on learning rate and learning plateau values; further tested through an effect size calculation. To assess prepositioning, scores were normalized and grouped by a measure of terminal device rotations. Scores then underwent a linear regression analysis. Optimal training lengths were found to be three and six sessions for modified Southampton Hand Assessment Procedure and Box and Blocks Test results respectively, with support from effect size calculations. Prepositioning and normalized score were weakly correlated, +0.38, and poorly fit, R 2 = 0.016, contradictory to the expected strong correlation that would accompany the supposed performance benefits attributed to prepositioning. A lack of resources to guide the use of upper limb bypass prostheses is addressed with the presented standard, quantitatively assessed protocol. A framework for evaluating adequate training length and prepositioning is established and shared.
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Affiliation(s)
- Conor Bloomer
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Sophie Wang
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA,Department of Bioengineering, University of Maryland, College Park, USA
| | - Kimberly Kontson
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA,Correspondence to: Kimberly Kontson, Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993, United States of America,
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Influence of the type of training task on intermanual transfer effects in upper-limb prosthesis training: A randomized pre-posttest study. PLoS One 2017; 12:e0188362. [PMID: 29190727 PMCID: PMC5708677 DOI: 10.1371/journal.pone.0188362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 10/31/2017] [Indexed: 11/19/2022] Open
Abstract
Intermanual transfer, the transfer of motor skills from the trained hand to the untrained hand, can be used to train upper limb prosthesis skills. The aim of this study was to determine the relation between the magnitude of the intermanual transfer effect and the type of training task. The used tasks were based on different aspects of prosthetic handling: reaching, grasping, grip-force production and functional tasks. A single-blinded clinical trial, with a pre-posttest design was executed. Seventy-one able-bodied, right-handed participants were randomly assigned to four training and two control groups. The training groups performed a training program with an upper-limb prosthesis simulator. One control group performed a sham training (a dummy training without the prosthesis simulator) and another control group received no training at all. The training groups and sham group trained on five consecutive days. To determine the improvement in skills, a test was administered before, immediately after, and one week after the training. Training was performed with the 'unaffected' arm; tests were performed with the 'affected' arm, with the latter resembling the amputated limb. In this study half of the participants trained with the dominant hand, while the other half trained with the non-dominant hand. Participants executed four tests that corresponded to the different training tasks. The tests measured the reaching (movement time and symmetry ratio), grasping (opening time, duration of maximum hand opening, and closing time), grip-force production (deviation of asked grip-force) and functional (movement time) performance. Half of the participants were tested with their dominant arm and half of the participants with their non-dominant arm. Intermanual transfer effects were not found for reaching, grasping or functional tasks. However, we did find intermanual transfer effects for grip-force production tasks. Possibly, the study design contributed to the negative results due to the duration of the training sessions and test sessions. The positive results of the grip-force production might be an effect of the specificity of the training, that was totally focused on training grip-force production. When using intermanual transfer training in novice amputees, specific training should be devoted to grip-force.
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Raveh E, Friedman J, Portnoy S. Visuomotor behaviors and performance in a dual-task paradigm with and without vibrotactile feedback when using a myoelectric controlled hand. Assist Technol 2017. [PMID: 28628379 DOI: 10.1080/10400435.2017.1323809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Prosthesis users allocate visual attention to their prosthetic hand while performing activities of daily living (ADLs), due to absence of sensory feedback. Dual-task assignments present competition for visual attention and may affect the performance of ADLs. Vibrotactile feedback (VTF) is a frequently-used method to provide prosthesis users with tactile feedback. However, the effect of adding VTF on visual attention and performance in a motor dual-task paradigm has not been investigated. Our aim was to compare visual attention and performance during ADLs in a motor dual-task paradigm when using binary VTF and without using VTF. Forty-three able-bodied subjects (age 26 ± 6.6 years) had a myoelectric-controlled hand attached to their right hand. The dual task comprised of a computer game played with the left hand, while manipulating objects with the artificial hand. This was performed with and without VTF in a counter-balanced order of two conditions. An eye-tracker monitored visual attention, while time to complete each task and the time the virtual car went off-road were recorded. No significant differences were found in visual attention or in performance time between the two conditions. Further examination of adding VTF to prosthesis users is recommended, with disrupted visual feedback and basic grasping tasks.
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Affiliation(s)
- Eitan Raveh
- a Occupational Therapy Department, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Jason Friedman
- b Physical Therapy Department, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Sigal Portnoy
- a Occupational Therapy Department, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Physical Medicine and Rehabilitation Department , Hadassah Medical Center , Jerusalem , Israel
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Tactile feedback is an effective instrument for the training of grasping with a prosthesis at low- and medium-force levels. Exp Brain Res 2017; 235:2547-2559. [PMID: 28550423 PMCID: PMC5502062 DOI: 10.1007/s00221-017-4991-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 05/17/2017] [Indexed: 10/26/2022]
Abstract
Grasping is a complex task routinely performed in an anticipatory (feedforward) manner, where sensory feedback is responsible for learning and updating the internal model of grasp dynamics. This study aims at evaluating whether providing a proportional tactile force feedback during the myoelectric control of a prosthesis facilitates learning a stable internal model of the prosthesis force control. Ten able-bodied subjects controlled a sensorized myoelectric prosthesis performing four blocks of consecutive grasps at three levels of target force (30, 50, and 70%), repeatedly closing the fully opened hand. In the first and third block, the subjects received tactile and visual feedback, respectively, while during the second and fourth block, the feedback was removed. The subjects also performed an additional block with no feedback 1 day after the training (Retest). The median and interquartile range of the generated forces was computed to assess the accuracy and precision of force control. The results demonstrated that the feedback was indeed an effective instrument for the training of prosthesis control. After the training, the subjects were still able to accurately generate the desired force for the low and medium target (30 and 50% of maximum force available in a prosthesis), despite the feedback being removed within the session and during the retest (low target force). However, the training was substantially less successful for high forces (70% of prosthesis maximum force), where subjects exhibited a substantial loss of accuracy as soon as the feedback was removed. The precision of control decreased with higher forces and it was consistent across conditions, determined by an intrinsic variability of repeated myoelectric grasping. This study demonstrated that the subject could rely on the tactile feedback to adjust the motor command to the prosthesis across trials. The subjects adjusted the mean level of muscle activation (accuracy), whereas the precision could not be modulated as it depends on the intrinsic myoelectric variability. They were also able to maintain the feedforward command even after the feedback was removed, demonstrating thereby a stable learning, but the retention depended on the level of the target force. This is an important insight into the role of feedback as an instrument for learning of anticipatory prosthesis force control.
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Huinink LHB, Bouwsema H, Plettenburg DH, van der Sluis CK, Bongers RM. Learning to use a body-powered prosthesis: changes in functionality and kinematics. J Neuroeng Rehabil 2016; 13:90. [PMID: 27716254 PMCID: PMC5054596 DOI: 10.1186/s12984-016-0197-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 09/27/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Little is known about action-perception learning processes underlying prosthetic skills in body-powered prosthesis users. Body-powered prostheses are controlled through a harness connected by a cable that might provide for limited proprioceptive feedback. This study aims to test transfer of training basic tasks to functional tasks and to describe the changes over time in kinematics of basic tasks of novice body-powered prosthesis users. METHODS Thirty able-bodied participants and 17 controls participated in the study, using a body-powered prosthetic simulator. Participants in the training group were divided over four groups and practiced during a 2-week-period either direct grasping, indirect grasping, fixation, or a combination of these tasks. Deformable objects with different compliances had to be manipulated while kinematic variables and grip force control were assessed. Functional performance was measured with the Southampton Hand Assessment Procedure (SHAP) prior to and after the training sessions, and after 2 weeks and 3 months retention. The control group only performed the SHAP tests. RESULTS All four training groups and the control group improved on the SHAP, also after a period of non-use. Type of training had a small but significant influence on the improvements of the SHAP score. On a kinematic level movement times decreased and hook closing velocities increased over time. The indirect grasping group showed significantly shorter plateau times than the other training groups. Grip force control only improved a little over training. CONCLUSIONS Training action-perception couplings of body-powered prosthesis in basic tasks transferred to functional tasks and this lasted after a period of non-use. During training movement times decreased and the indirect grasping group showed advantages. It is advisable to start body-powered training with indirect grasping tasks but also to practice hook-object orientations.
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Affiliation(s)
- Laura H. B. Huinink
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 196, Groningen, NL-9700 AD The Netherlands
| | - Hanneke Bouwsema
- Adelante Rehabilitation Centre, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Dick H. Plettenburg
- Department of BioMechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Corry K. van der Sluis
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Raoul M. Bongers
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 196, Groningen, NL-9700 AD The Netherlands
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Chadwell A, Kenney L, Thies S, Galpin A, Head J. The Reality of Myoelectric Prostheses: Understanding What Makes These Devices Difficult for Some Users to Control. Front Neurorobot 2016; 10:7. [PMID: 27597823 PMCID: PMC4992705 DOI: 10.3389/fnbot.2016.00007] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/25/2016] [Indexed: 11/13/2022] Open
Abstract
Users of myoelectric prostheses can often find them difficult to control. This can lead to passive-use of the device or total rejection, which can have detrimental effects on the contralateral limb due to overuse. Current clinically available prostheses are “open loop” systems, and although considerable effort has been focused on developing biofeedback to “close the loop,” there is evidence from laboratory-based studies that other factors, notably improving predictability of response, may be as, if not more, important. Interestingly, despite a large volume of research aimed at improving myoelectric prostheses, it is not currently known which aspect of clinically available systems has the greatest impact on overall functionality and everyday usage. A protocol has, therefore, been designed to assess electromyographic (EMG) skill of the user and predictability of the prosthesis response as significant parts of the control chain, and to relate these to functionality and everyday usage. Here, we present the protocol and results from early pilot work. A set of experiments has been developed. First, to characterize user skill in generating the required level of EMG signal, as well as the speed with which users are able to make the decision to activate the appropriate muscles. Second, to measure unpredictability introduced at the skin–electrode interface, in order to understand the effects of the socket-mounted electrode fit under different loads on the variability of time taken for the prosthetic hand to respond. To evaluate prosthesis user functionality, four different outcome measures are assessed. Using a simple upper limb functional task prosthesis users are assessed for (1) success of task completion, (2) task duration, (3) quality of movement, and (4) gaze behavior. To evaluate everyday usage away from the clinic, the symmetricity of their real-world arm use is assessed using activity monitoring. These methods will later be used to assess a prosthesis user cohort to establish the relative contribution of each control factor to the individual measures of functionality and everyday usage (using multiple regression models). The results will support future researchers, designers, and clinicians in concentrating their efforts on the area that will have the greatest impact on improving prosthesis use.
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Affiliation(s)
- Alix Chadwell
- Centre for Health Sciences Research, University of Salford , Salford , UK
| | - Laurence Kenney
- Centre for Health Sciences Research, University of Salford , Salford , UK
| | - Sibylle Thies
- Centre for Health Sciences Research, University of Salford , Salford , UK
| | - Adam Galpin
- Centre for Health Sciences Research, University of Salford , Salford , UK
| | - John Head
- Centre for Health Sciences Research, University of Salford , Salford , UK
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Hughey L, Wheaton LA. Incidental Learning and Explicit Recall in Upper Extremity Prosthesis Use: Insights Into Functional Rehabilitation Challenges. J Mot Behav 2016; 48:519-526. [PMID: 27341554 DOI: 10.1080/00222895.2016.1152223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Loss of an upper extremity and the resulting rehabilitation often requires individuals to learn how to use a prosthetic device for activities of daily living. It remains unclear how prostheses affect motor learning outcomes. The authors' aim was to evaluate whether incidental motor learning and explicit recall is affected in intact persons either using prostheses (n = 10) or the sound limb (n = 10), and a chronic amputee on a modified serial reaction time task. Latency and accuracy of task completion were recorded over six blocks, with a distractor task between blocks 5 and 6. Participants were also asked to recall the sequence immediately following the study and at a 24-hr follow-up. Prosthesis users demonstrate patterns consistent with implicit learning, with sustained error patterns with the distal terminal device. More intact individuals were able to explicitly recall the sequence initially, however there was no significant difference 24 hr following the study. Acute incidental motor learning does not appear to diminish task related error patterns or accompany with explicit recall in prosthesis users, which could present limitations for acute training of prosthesis use in amputees. This suggests differing mechanisms of visuospatial sequential learning and motor control with prostheses.
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Affiliation(s)
- Laura Hughey
- a School of Applied Physiology, Georgia Institute of Technology , Atlanta , Georgia
| | - Lewis A Wheaton
- a School of Applied Physiology, Georgia Institute of Technology , Atlanta , Georgia
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de Boer E, Romkema S, Cutti AG, Brouwers MA, Bongers RM, van der Sluis CK. Intermanual Transfer Effects in Below-Elbow Myoelectric Prosthesis Users. Arch Phys Med Rehabil 2016; 97:1924-1930. [PMID: 27240431 DOI: 10.1016/j.apmr.2016.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/28/2016] [Accepted: 04/30/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine intermanual transfer effects in patients with a below-elbow amputation using a myoelectric prosthesis and to establish whether laterality affects these effects. DESIGN Case-control. SETTING A standardized setting in a rehabilitation clinic. PARTICIPANTS A convenience sample (N=44) of experienced myoelectric prosthesis users (n=22) and matched controls (n=22). Controls were matched on sex, age (±5y), and hand dominance. INTERVENTIONS Both the experienced group and the control group performed several tasks using a prosthesis simulator attached to their nonaffected arm. MAIN OUTCOME MEASURES Movement time, force control, Box and Block test (BBT) scores, and duration of hand opening. RESULTS Movement times of myoelectric prosthesis users were shorter, and these users had significantly higher BBT scores and shorter hand opening durations than those of controls. No intermanual transfer effects on force control and no laterality effects were found. CONCLUSIONS Intermanual transfer effects were present in experienced myoelectric prosthesis users with a below-elbow amputation, independent of laterality. These findings support the clinical relevance of intermanual transfer training, which may facilitate persons with an upper limb amputation to start training directly after the amputation.
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Affiliation(s)
- Errit de Boer
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sietske Romkema
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea G Cutti
- Italian Workers' Compensation Authority, Vigorso di Budrio, Bologna, Italy
| | | | - Raoul M Bongers
- Center of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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van Dijk L, van der Sluis CK, van Dijk HW, Bongers RM. Task-Oriented Gaming for Transfer to Prosthesis Use. IEEE Trans Neural Syst Rehabil Eng 2015; 24:1384-1394. [PMID: 26625419 DOI: 10.1109/tnsre.2015.2502424] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of this study is to establish the effect of task-oriented video gaming on using a myoelectric prosthesis in a basic activity of daily life (ADL). Forty-one able-bodied right-handed participants were randomly assigned to one of four groups. In three of these groups the participants trained to control a video game using the myosignals of the flexors and extensors of the wrist: in the Adaptive Catching group participants needed to catch falling objects by opening and closing a grabber and received ADL-relevant feedback during performance. The Free Catching group used the same game, but without augmented feedback. The Interceptive Catching group trained a game where the goal was to intercept a falling object by moving a grabber to the left and right. They received no additional feedback. The control group played a regular Mario computer game. All groups trained 20 minutes a day for four consecutive days. Two tests were conducted before and after training: one level of the training game was performed, and participants grasped objects with a prosthesis simulator. Results showed all groups improved their game performance over controls. In the prosthesis-simulator task, after training the Adaptive Catching group outperformed the other groups in their ability to adjust the hand aperture to the size of the objects and the degree of compression of compressible objects. This study is the first to demonstrate transfer effects from a serious game to a myoelectric prosthesis task. The specificity of the learning effects suggests that research into serious gaming will benefit from placing ADL-specific constraints on game development.
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Romkema S, Bongers RM, van der Sluis CK. Influence of Inter-Training Intervals on Intermanual Transfer Effects in Upper-Limb Prosthesis Training: A Randomized Pre-Posttest Study. PLoS One 2015; 10:e0128747. [PMID: 26075396 PMCID: PMC4468151 DOI: 10.1371/journal.pone.0128747] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/30/2015] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Improvement in prosthetic training using intermanual transfer (the transfer of motor skills from the trained, “unaffected” hand to the untrained, “affected” hand) has been shown in previous studies. The aim of this study is to determine the influence of the inter-training interval on the magnitude of the intermanual transfer effects. This was done using a mechanistic, randomized, single-blinded pretest-posttest design. Sixty-four able-bodied, right-handed participants were randomly assigned to the Short and Long Interval Training Groups and the Short and Long Interval Control Groups. The Short and Long Interval Training Groups used a prosthesis simulator in their training program. The Short and Long Interval Control Groups executed a sham training program, that is, a dummy training program in which the same muscles were trained as with the prosthesis simulator. The Short Interval Training Group and the Short Interval Control Groups trained on consecutive days, while the Long Interval Training Group and Long Interval Control Group trained twice a week. To determine the improvement in skills, a test was administered before, immediately after, and at two points in time after the training. Training was performed with the “unaffected” arm; tests were performed with the “affected” arm. The outcome measurements were: the movement time (the time from the beginning of the movement until completion of the task); the duration of maximum hand opening, (the opening of the prosthetic hand while grasping an object); and the grip-force control (the error from the required grip-force during a tracking task). Intermanual transfer was found in movement times, but not in hand opening or grip-force control. The length of the inter-training interval did not affect the magnitude of intermanual transfer effects. No difference in the intermanual transfer effect in upper-limb prosthesis training was found for training on a daily basis as compared to training twice a week. TRIAL REGISTRATION Nederlands Trial Register NTR3888.
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Affiliation(s)
- Sietske Romkema
- University of Groningen, University Medical Center Groningen Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Raoul M. Bongers
- University of Groningen, University Medical Center Groningen, Center of Human Movement Sciences, Groningen, the Netherlands
| | - Corry K. van der Sluis
- University of Groningen, University Medical Center Groningen Department of Rehabilitation Medicine, Groningen, the Netherlands
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Intermanual transfer effect in young children after training in a complex skill: mechanistic, pseudorandomized, pretest-posttest study. Phys Ther 2015; 95:730-9. [PMID: 25504483 DOI: 10.2522/ptj.20130490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/23/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intermanual transfer implies that motor skills learned on one side of the body transfer to the untrained side. This effect was previously noted in adults practicing with a prosthesis simulator. OBJECTIVE The study objective was to determine whether intermanual transfer is present in children practicing prosthetic handling. DESIGN A mechanistic, pseudorandomized, pretest-posttest design was used. SETTING The study was conducted in a primary school in the Netherlands. PARTICIPANTS The participants were children who were able-bodied (N=48; 25 boys, 23 girls; mean age=5.1 years) and randomly assigned to an experimental group or a control group. INTERVENTION The experimental group performed 5 training sessions using a prosthesis simulator on the training arm. Before (pretest), immediately after (posttest), and 6 days after (retention test) the training program, their ability to handle the prosthesis with the contralateral (test) arm was measured. The control group only performed the tests. Half of the children performed the tests with the dominant hand, and the other half performed the tests with the nondominant hand. MEASUREMENTS During the tests, movement time and control of force were measured. RESULTS An interaction effect of group by test was found for movement time. Post hoc tests revealed significant improvement in the experimental group between the posttest and the retention test. No force control effect was found. LIMITATIONS Only children who were able-bodied were included. Measurements should have been masked and obtained without tester interference. The fact that 4 children whose results were slower than the mean result discontinued training may have biased the findings. CONCLUSIONS The intermanual transfer effect was present in 5-year-old children undergoing training in prosthetic handling. After training of one hand, children's movement times for the other, untrained hand improved. This finding may be helpful for training children who are novice users of a prosthesis.
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Golenia L, Schoemaker MM, Mouton LJ, Bongers RM. Individual differences in learning a novel discrete motor task. PLoS One 2014; 9:e112806. [PMID: 25386708 PMCID: PMC4227849 DOI: 10.1371/journal.pone.0112806] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 10/17/2014] [Indexed: 11/19/2022] Open
Abstract
Many motor learning studies focus on average performance while it is known from everyday life experience that humans differ in their way of learning new motor tasks. This study emphasises the importance of recognizing individual differences in motor learning. We studied individual tool grasping profiles of individuals who learned to pick up objects with a novel tool, a pair of pliers. The pair of pliers was attached to the thumb and the index finger so that the tip of the thumb and the tip of the index finger were displaced to the beaks of the pair of pliers. The grasp component was manipulated by varying the location of the hinge of the pair of pliers, which resulted in different relations between beak opening and closing and finger opening and closing. The Wider Beak group had the hinge at 7 cm, the Same Beak group had the hinge at 10 cm (i.e., in the middle), and the Smaller Beak group had the hinge at 13 cm from the digits. Each group consisted of ten right-handed participants who picked up an object with one of the pairs of pliers 200 times on two subsequent days. Hand opening, plateau phase, hand closing, grasping time and maximum aperture were analyzed. To characterize individual changes over practice time, a log function was fitted on these dependent variables and the ratio of improvement was determined. Results showed that at the beginning stage of tool use learning the characteristic grasping profile consisted of three phases; hand opening, plateau phase and hand closing. Over practicing individual participants differed in the number of phases that changed, the amount of change in a phase and/or the direction of change. Moreover, with different pliers different learning paths were found. The importance of recognizing individual differences in motor learning is discussed.
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Affiliation(s)
- Laura Golenia
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Marina M. Schoemaker
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Leonora J. Mouton
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Raoul M. Bongers
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- * E-mail:
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Major MJ, Stine RL, Heckathorne CW, Fatone S, Gard SA. Comparison of range-of-motion and variability in upper body movements between transradial prosthesis users and able-bodied controls when executing goal-oriented tasks. J Neuroeng Rehabil 2014; 11:132. [PMID: 25192744 PMCID: PMC4164738 DOI: 10.1186/1743-0003-11-132] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/02/2014] [Indexed: 01/11/2023] Open
Abstract
Background Current upper limb prostheses do not replace the active degrees-of-freedom distal to the elbow inherent to intact physiology. Limited evidence suggests that transradial prosthesis users demonstrate shoulder and trunk movements to compensate for these missing volitional degrees-of-freedom. The purpose of this study was to enhance understanding of the effects of prosthesis use on motor performance by comparing the movement quality of upper body kinematics between transradial prosthesis users and able-bodied controls when executing goal-oriented tasks that reflect activities of daily living. Methods Upper body kinematics were collected on six able-bodied controls and seven myoelectric transradial prosthesis users during execution of goal-oriented tasks. Range-of-motion, absolute kinematic variability (standard deviation), and kinematic repeatability (adjusted coefficient-of-multiple-determination) were quantified for trunk motion in three planes, shoulder flexion/extension, shoulder ab/adduction, and elbow flexion/extension across five trials per task. Linear mixed models analysis assessed between-group differences and correlation analysis evaluated association between prosthesis experience and kinematic repeatability. Results Across tasks, prosthesis users demonstrated increased trunk motion in all three planes and shoulder abduction compared to controls (p ≤ 0.004). Absolute kinematic variability was greater for prosthesis users for all degrees-of-freedom irrespective of task, but was significant only for degrees-of-freedom that demonstrated increased range-of-motion (p ≤ 0.003). For degrees-of-freedom that did not display increased absolute variability for prosthesis users, able-bodied kinematics were characterized by significantly greater repeatability (p ≤ 0.015). Prosthesis experience had a strong positive relationship with average kinematic repeatability (r = 0.790, p = 0.034). Conclusions The use of shoulder and trunk movements by prosthesis users as compensatory motions to execute goal-oriented tasks demonstrates the flexibility and adaptability of the motor system. Increased variability in movement suggests that prosthesis users do not converge on a defined motor strategy to the same degree as able-bodied individuals. Kinematic repeatability may increase with prosthesis experience, or encourage continued device use, and future work is warranted to explore these relationships. As compensatory dynamics may be necessary to improve functionality of transradial prostheses, users may benefit from dedicated training that encourages optimization of these dynamics to facilitate execution of daily living activity, and fosters adaptable but reliable motor strategies. Electronic supplementary material The online version of this article (doi:10.1186/1743-0003-11-132) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Suite 1100, Chicago, IL 60611, USA.
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Lum PS, Black I, Holley RJ, Barth J, Dromerick AW. Internal models of upper limb prosthesis users when grasping and lifting a fragile object with their prosthetic limb. Exp Brain Res 2014; 232:3785-95. [PMID: 25142151 DOI: 10.1007/s00221-014-4071-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
Internal models allow unimpaired individuals to appropriately scale grip force when grasping and lifting familiar objects. In prosthesis users, the internal model must adapt to the characteristics of the prosthetic devices and reduced sensory feedback. We studied the internal models of 11 amputees and eight unimpaired controls when grasping and lifting a fragile object. When the object was modified from a rigid to fragile state, both subject groups adapted appropriately by significantly reducing grasp force on the first trial with the fragile object compared to the rigid object (p < 0.020). There was a wide range of performance skill illustrated by amputee subjects when lifting the fragile object in 10 repeated trials. One subject, using a voluntary close device, never broke the object, four subjects broke the fragile device on every attempt and seven others failed on their initial attempts, but improved over the repeated trials. Amputees decreased their grip forces 51 ± 7 % from the first to the last trial (p < 0.001), indicating a practice effect. However, amputees used much higher levels of force than controls throughout the testing (p < 0.015). Amputees with better performance on the Box and Blocks test used lower grip force levels (p = 0.006) and had more successful lifts of the fragile object (p = 0.002). In summary, amputees do employ internal models when picking up objects; however, the accuracy of these models is poor and grip force modulation is significantly impaired. Further studies could examine the alternative sensory modalities and training parameters that best promote internal model formation.
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Affiliation(s)
- Peter S Lum
- Biomedical Engineering, The Catholic University of America, Pangborn Hall, room 131, 620 Michigan Ave NE, Washington, DC, 20064, USA,
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Bouwsema H, van der Sluis CK, Bongers RM. Effect of feedback during virtual training of grip force control with a myoelectric prosthesis. PLoS One 2014; 9:e98301. [PMID: 24865570 PMCID: PMC4035328 DOI: 10.1371/journal.pone.0098301] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/30/2014] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to determine whether virtual training improves grip force control in prosthesis use, and to examine which type of augmented feedback facilitates its learning most. Thirty-two able-bodied participants trained grip force with a virtual ball-throwing game for five sessions in a two-week period, using a myoelectric simulator. They received either feedback on movement outcome or on movement execution. Sixteen controls received training that did not focus on force control. Variability over learning was examined with the Tolerance-Noise-Covariation approach, and the transfer of grip force control was assessed in five test-tasks that assessed different aspects of force control in a pretest, a posttest and a retention test. During training performance increased while the variability in performance was decreased, mainly by reduction in noise. Grip force control only improved in the test-tasks that provided information on performance. Starting the training with a task that required low force production showed no transfer of the learned grip force. Feedback on movement execution was detrimental to grip force control, whereas feedback on movement outcome enhanced transfer of grip force control to tasks other than trained. Clinical implications of these results regarding virtual training of grip force control are discussed.
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Affiliation(s)
- Hanneke Bouwsema
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
- * E-mail:
| | - Corry K. van der Sluis
- University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands
| | - Raoul M. Bongers
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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