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Shimizu Y, Mori T, Yoshikawa K, Katane D, Torishima H, Hara Y, Yozu A, Yamazaki M, Hada Y, Mutsuzaki H. Developing a Novel Prosthetic Hand with Wireless Wearable Sensor Technology Based on User Perspectives: A Pilot Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2765. [PMID: 38732871 PMCID: PMC11086240 DOI: 10.3390/s24092765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
Myoelectric hands are beneficial tools in the daily activities of people with upper-limb deficiencies. Because traditional myoelectric hands rely on detecting muscle activity in residual limbs, they are not suitable for individuals with short stumps or paralyzed limbs. Therefore, we developed a novel electric prosthetic hand that functions without myoelectricity, utilizing wearable wireless sensor technology for control. As a preliminary evaluation, our prototype hand with wireless button sensors was compared with a conventional myoelectric hand (Ottobock). Ten healthy therapists were enrolled in this study. The hands were fixed to their forearms, myoelectric hand muscle activity sensors were attached to the wrist extensor and flexor muscles, and wireless button sensors for the prostheses were attached to each user's trunk. Clinical evaluations were performed using the Simple Test for Evaluating Hand Function and the Action Research Arm Test. The fatigue degree was evaluated using the modified Borg scale before and after the tests. While no statistically significant differences were observed between the two hands across the tests, the change in the Borg scale was notably smaller for our prosthetic hand (p = 0.045). Compared with the Ottobock hand, the proposed hand prosthesis has potential for widespread applications in people with upper-limb deficiencies.
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Affiliation(s)
- Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
- Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Takahiko Mori
- Department of Electrical and Electronic Engineering, Shonan Institute of Technology, Fujisawa 251-8511, Japan
| | - Kenichi Yoshikawa
- Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Daisuke Katane
- Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Hiroyuki Torishima
- Saitama Prosthetics and Orthotics Manufacturing Service Co., Ltd., Saitama 337-0051, Japan
| | - Yuki Hara
- Department of Neurophysiology, National Center of Neurology and Psychiatry, Kodaira 187-8551, Japan
| | - Arito Yozu
- Department of Precision Engineering, University of Tokyo, Bunkyo 113-8656, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Hirotaka Mutsuzaki
- Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0331, Japan
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Gahrn-Andersen R, Prinz R. Ensuring wholeness: Using Code Biology to overcome the autonomy-heteronomy divide. Biosystems 2023; 226:104874. [PMID: 36924984 DOI: 10.1016/j.biosystems.2023.104874] [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: 09/13/2022] [Revised: 02/03/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
This paper presents an alternative to Autopoietic Enactivism in the form of a Code Biology-informed account on human sense-making. It demonstrates the possibility of avoiding a dualism between, on the one hand, the autonomy of individual sense-makers and, on the other, the heteronomy of social facts. This is possible because code biological principles are pertinent to different levels of biological and non-biological organization and cut across the organismic self-non-self border. Analytically, one can maintain the overall integrity of an agent as a separable unit of (inter)action while also avoiding an autonomy-heteronomy divide. We therefore emphasise the constitutive role of codified relations that, while irreducible to operational closure, connect the sense-making agent's social interactions to those of other agents. The move grants a central, constitutive role to external norms (or, heteronomy) as altering the internal, embodied integrity of an autonomous agent. Drawing on the case of prosthetics use in amputees, we show that successful integration of a prothesis cannot be reduced to the substitution of a missing limb. Rather, it demands experienced bodily wholeness on the part of the agent which can only be achieved by attuning and adapting to use of a prosthesis while also internalizing social norms and values. It is concluded that many aspects of the living actualize codified relations which incorporate both heteronomous and autonomous traits.
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Affiliation(s)
- Rasmus Gahrn-Andersen
- Department of Language, Culture, History and Communication, University of Southern Denmark, Denmark.
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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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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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Home intervention for children and adolescents with unilateral trans-radial and partial carpal reduction deficiencies. Sci Rep 2022; 12:7447. [PMID: 35523915 PMCID: PMC9076824 DOI: 10.1038/s41598-022-11470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Current training interventions assessing pediatric functional motor skills do not account for children and adolescents with upper limb reductions who utilize a prosthesis. Prosthesis rejection showed that 1 out of 5 prosthesis users will reject their prosthesis due to lack of durability, lack of function, not meeting the participant’s needs, perceived lack of need, and medical restrictions indicating that prosthetic users believed they were more functional without the device. It was hypothesized that an 8-week Home Intervention program will result in significant improvements in gross manual dexterity, bimanual coordination, and the functional activities performed during the program. It was also hypothesized that the novel Prosthesis Measurement of Independent Function (PMIF) score will reflect the Home Intervention performance improvements. Five pediatric participants (ages 5–19 years) with congenital upper limb reductions were fitted with a 3D printed upper extremity prosthesis for their affected limb. Participants then completed the 8-week Home Intervention which included Training activities completed 2×/week for 8 weeks and Non-Training activities completed only at week 1 and week 8. Participant’s times were recorded along with each participant receiving a PMIF score ranging from 0 = unable to complete activity, to 7 = complete independence with activity completion. Results showed a decrease in overall averaged activity times amongst all activities. For all activities performed, individual averaged time decreased with the exception of Ball Play which increased over the 8-week intervention period. There was significant interaction for Home Intervention performance with F = 2.904 (p = 0.003). All participants increased their PMIF scores to 7 (complete independence) at the end of the 8 week intervention period. Decreases in time averages and increases in PMIF scores indicate that learning and functional use of the prostheses have occurred amongst the pediatric participants.
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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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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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Resnik L, Borgia M, Cancio JM, Delikat J, Ni P. Psychometric evaluation of the Southampton hand assessment procedure (SHAP) in a sample of upper limb prosthesis users. J Hand Ther 2021; 36:110-120. [PMID: 34400030 DOI: 10.1016/j.jht.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 06/22/2021] [Accepted: 07/04/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND The 26-item Southampton Hand Assessment Protocol (SHAP) is a test of prosthetic hand function that generates an Index of Functionality (IOF), and prehensile pattern (PP) scores. Prior researchers identified potential issues in SHAP scoring, proposing alternative scoring methods (LIF and W-LIF). STUDY DESIGN Cross-sectional study. PURPOSE Evaluate the psychometric properties of the SHAP IOF, LIF, and W-LIF and PP scores and develop the Prosthesis Index of Functionality (P-IOF). METHODS We examined item completion, floor andceiling effects, concurrent, discriminant, construct and structural validity. The P-IOF used increased boundary limits and information from item completion and completion time. Calibration used a nonlinear mixed model. Scores were estimated using maximum a posteriori Bayesian estimation. Mixed integer linear programing (MILP) informed development of a shorter measure. Validity analyses were repeated using the P-IOF. RESULTS 126 persons, mean age 57 (sd 15.8), 69% with transradial amputation were included. Floors effects were observed in 18.3%-19.1% for the IOF, LIF, and W-LIF. Ten items were not completed by >15% of participants. Boundary limits were problematic for all but 1 item. Correlations with dexterity measures were strong (r = 0.54-0.73). Scores differed by amputation level (p > .0001). Factor analysis did not support use of PP scores. The P-IOF used expanded boundary limits to decrease floor effects. MILP identified 10 items that could be dropped. The 26-item P-IOF and 16-item P-IOF had reduced floor effects (<7.5%), strong evidence of concurrent and discriminant validity, and construct validity. P-IOF reduced administrative burden by 9.5 (sd 5.6) minutes. DISCUSSION Floor effects limit a measure's ability to distinguish between persons with low function. CONCLUSION Analyses supported the validity of the SHAP IOF, LIF, and W-LIF, but identified large floor effects, as well as issues with structural validity of the PP scores. The 16-item P-IOF minimizes floor effects and reduces administrative burden.
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Affiliation(s)
- Linda Resnik
- Providence VA Medical Center, Providence, RI, USA; Health Services, Policy and Practice, Brown University, Providence, RI, USA.
| | | | - Jill M Cancio
- United States Army Institute of Surgical Research Burn Center, JBSA Ft. Sam Houston, TX, USA
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Changes in Sensorimotor Cortical Activation in Children Using Prostheses and Prosthetic Simulators. Brain Sci 2021; 11:brainsci11080991. [PMID: 34439610 PMCID: PMC8392534 DOI: 10.3390/brainsci11080991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to examine the neural responses of children using prostheses and prosthetic simulators to better elucidate the emulation abilities of the simulators. We utilized functional near-infrared spectroscopy (fNIRS) to evaluate the neural response in five children with a congenital upper limb reduction (ULR) using a body-powered prosthesis to complete a 60 s gross motor dexterity task. The ULR group was matched with five typically developing children (TD) using their non-preferred hand and a prosthetic simulator on the same hand. The ULR group had lower activation within the primary motor cortex (M1) and supplementary motor area (SMA) compared to the TD group, but nonsignificant differences in the primary somatosensory area (S1). Compared to using their non-preferred hand, the TD group exhibited significantly higher action in S1 when using the simulator, but nonsignificant differences in M1 and SMA. The non-significant differences in S1 activation between groups and the increased activation evoked by the simulator's use may suggest rapid changes in feedback prioritization during tool use. We suggest that prosthetic simulators may elicit increased reliance on proprioceptive and tactile feedback during motor tasks. This knowledge may help to develop future prosthesis rehabilitative training or the improvement of tool-based skills.
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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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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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Brack R, Amalu EH. A review of technology, materials and R&D challenges of upper limb prosthesis for improved user suitability. J Orthop 2021; 23:88-96. [PMID: 33442223 DOI: 10.1016/j.jor.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022] Open
Abstract
Introduction Hand amputation significantly challenges one's independence in carrying out daily activities. With the UK and Italy recoding circa 5200 and 3500 upper limb (UL) amputations (ULAs) yearly, respectively, and about 541,000 Americans losing ULs in 2005, incidence victims constitute a considerable proportion of our population and should be adequately supported. The use of upper limb prosthesis (ULP) offers amputees a new opportunity of living a quality life - but poses challenges on the physically and psychologically traumatised. With reports that up to 20% of adult UL amputees choose not to use a prosthesis, roughly 26% of adults and 45% of children and adolescents are dissatisfied with their devices and abandon them with reasons of poor solution to basic needs, a review of ULP for suitability has become crucial. Objectives These include, to review UL prosthetic technology (PT), the materials used in the manufacturing of ULP, challenges in research and development of ULP, and to advise on the suitability of different devices to the needs of amputees. Methods They involve an extensive review of relevant literature and application of statistics to analyse data obtained from literature. Results ULAs are characterised to show affected bones in seven types of amputations. The characterisation depicts key causes of incidences that lead to amputations while advising on device suitability. PT is classified in terms of cost, nature, functions/operations of each type of device while providing the design challenges. Users' opinions on PT materials are analysed and used to suggest new materials for the next generation of the devices. R&D challenges hindering future developments of PT is reviewed and results used to identify characteristics for the next generation of the technology. Conclusions To increase user satisfaction and reduce device abandonment, amputees need useful information on the trend in PT and engineers need information about device field performance for improvements. The use of better performing ULP will improve users' everyday lives.
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Affiliation(s)
- Robbie Brack
- Department of Engineering, School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, TS1 3BA, UK
| | - Emeka H Amalu
- Department of Engineering, School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, TS1 3BA, UK
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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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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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Valevicius AM, Boser QA, Chapman CS, Pilarski PM, Vette AH, Hebert JS. Compensatory strategies of body-powered prosthesis users reveal primary reliance on trunk motion and relation to skill level. Clin Biomech (Bristol, Avon) 2020; 72:122-129. [PMID: 31862606 DOI: 10.1016/j.clinbiomech.2019.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND While body-powered prostheses are commonly used, the compensatory strategies required to operate body-powered devices are not well understood. Kinematic assessment in addition to standard clinical tests can give a comprehensive evaluation of prosthesis user function and skill. This study investigated the movement compensations of body-powered prosthesis users and determined whether a correlation is present between compensatory strategies and skill level, as measured by a standard clinical test. METHODS Five transradial body-powered prosthesis users completed two standardized upper limb tasks. A 12-camera motion capture system was used to obtain three-dimensional angular kinematics for eight degrees of freedom at the trunk, shoulder, and elbow. Range of motion was compared to a normative dataset. Pearson's correlation was used to assess the relationship between the Activities Measure for Upper Limb Amputees and range of motion for each degree of freedom. FINDINGS Participants displayed a statistically significant (P < .05) increase in range of motion at the trunk for both tasks. Shoulder flexion/extension range of motion was significantly reduced (P < .05) compared to normative values, but shoulder abduction/adduction range of motion did not show a consistent difference compared to norms. Skill level was correlated with range of motion for specific degrees of freedom at the trunk, shoulder, and elbow. INTERPRETATION Body-powered prosthesis users compensated with trunk movement and showed reduced motion for shoulder flexion/extension, with relatively normal shoulder abduction/adduction. Skill level was correlated with angular kinematic strategies, which may allow targeting of specific therapeutic interventions for reducing compensatory movements.
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Affiliation(s)
- Aïda M Valevicius
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada
| | - Quinn A Boser
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, 5005 Katz Group Centre, Edmonton, Alberta T6G 2E1, Canada
| | - Craig S Chapman
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, Alberta T6G 2H9, Canada
| | - Patrick M Pilarski
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, 5005 Katz Group Centre, Edmonton, Alberta T6G 2E1, Canada
| | - Albert H Vette
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada; Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, 9211 116 Street NW, Edmonton, Alberta T6G 1H9, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta T5G 0B7, Canada
| | - Jacqueline S Hebert
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada; Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, 5005 Katz Group Centre, Edmonton, Alberta T6G 2E1, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta T5G 0B7, Canada.
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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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Artificial-Hand Technology—Current State of Knowledge in Designing and Forecasting Changes. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9194090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The subject of human-hand versatility has been intensively investigated for many years. Emerging robotic constructions change continuously in order to mimic natural mechanisms as accurately as possible. Such an attitude is motivated by the demand for humanoid robots with sophisticated end effectors and highly biomimic prostheses. This paper provides wide analysis of more than 80 devices that have been created over the last 40 years. It compares both the mechanical structure and various actuators from conventional DC motors and servomechanisms, through pneumatic muscles, to soft actuators and artificial muscles. Described measured factors include angles, forces, torques, tensions, and tactiles. Furthermore, the appropriate statistics of kinematic configuration, as well as the type or number of drive units and sensory systems, show not only recent problems, but also trends that will be followed in the future.
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20
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Trent L, Intintoli M, Prigge P, Bollinger C, Walters LS, Conyers D, Miguelez J, Ryan T. A narrative review: current upper limb prosthetic options and design. Disabil Rehabil Assist Technol 2019; 15:604-613. [PMID: 30973275 DOI: 10.1080/17483107.2019.1594403] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: This review was conducted to provide an overview of current literature as it relates to upper limb difference, available componentry, and prosthetic options and design. Emerging technologies combined with an increased awareness of the limb difference community have contributed to recent advancements in upper extremity prosthetics.Methods: A search of five major clinical databases utilizing keywords relating to upper limb prostheses, componenty and limb difference levels resulted in over 1200 articles. These articles were subjected to inclusion and exclusion criteria in order to identify current peer reviewed research relevant to this topic.Results: Fifty-five applicable articles and sources of standards were reviewed based on the inclusion and exclusion criteria, presenting five general options for prosthetic intervention. This information was assimilated and categorized in this article, which provides an overview of the aforementioned options.Conclusion: While a noteworthy amount of research focuses on technological advancements, the five options for prosthetic intervention are inherently represented in the current literature. For individuals with upper limb difference, as well as their care team, successful rehabilitation hinges on awareness of new components, the functional efficacy of these components, and the evolved techniques used in prosthetic design and fabrication. It is noted that the rapid evolution of upper limb prosthetics consistently outpaces research and publication of information.Implications for rehabilitationTo provide an overview of prosthetic design considerations and options to help create a more informed rehabilitation team, leading to improved outcomes in prescription and management of upper limb prosthetics.To bring awareness of current research in the field of upper limb prosthetics in order to provoke further exploration of the efficacy of prosthetic options and design considerations.
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21
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Wang S, Hsu CJ, Trent L, Ryan T, Kearns NT, Civillico EF, Kontson KL. Evaluation of Performance-Based Outcome Measures for the Upper Limb: A Comprehensive Narrative Review. PM R 2018; 10:951-962.e3. [PMID: 29474995 DOI: 10.1016/j.pmrj.2018.02.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 01/17/2023]
Abstract
Objective performance-based outcome measures (OMs) have the potential to provide unbiased and reproducible assessments of limb function. However, very few of these performance-based OMs have been validated for upper limb (UL) prosthesis users. OMs validated in other clinical populations (eg, neurologic or musculoskeletal conditions) could be used to fill gaps in existing performance-based OMs for UL amputees. Additionally, a joint review might reveal consistent gaps across multiple clinical populations. Therefore, the objective of this review was to systematically characterize prominent measures used in both sets of clinical populations with regard to (1) location of task performance around the body, (2) possible grips employed, (3) bilateral versus unilateral task participation, and (4) details of scoring mechanisms. A systematic literature search was conducted in EMBASE, Medline, and Cumulative Index to Nursing and Allied Health electronic databases for variations of the following terms: stroke, musculoskeletal dysfunction, amputation, prosthesis, upper limb, outcome, assessments. Articles were included if they described performance-based OMs developed for disabilities of the UL. Results show most tasks were performed with 1 hand in the space directly in front of the participant. The tip, tripod, and cylindrical grips were most commonly used for the specific tasks. Few measures assessed sensation and movement quality. Overall, several limitations in OMs were identified. The solution to these limitations may be to modify and validate existing measures originally developed for other clinical populations as first steps to more aptly measure prosthesis use while more complete assessments for UL prosthesis users are being developed. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sophie Wang
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Labs, Division of Biomedical Physics, Silver Spring, MD; and University of Maryland, Department of Biomedical Engineering, College Park, MD(∗)
| | | | | | | | - Nathan T Kearns
- Advanced Arm Dynamics, Redondo Beach, CA; and University of North Texas, Department of Psychology, Denton, TX(¶)
| | | | - Kimberly L Kontson
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Labs, Division of Biomedical Physics, 10903 New Hampshire Ave, Silver Spring, MD 20993(∗∗).
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22
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Schweitzer W, Thali MJ, Egger D. Case-study of a user-driven prosthetic arm design: bionic hand versus customized body-powered technology in a highly demanding work environment. J Neuroeng Rehabil 2018; 15:1. [PMID: 29298708 PMCID: PMC5751817 DOI: 10.1186/s12984-017-0340-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 12/11/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Prosthetic arm research predominantly focuses on "bionic" but not body-powered arms. However, any research orientation along user needs requires sufficiently precise workplace specifications and sufficiently hard testing. Forensic medicine is a demanding environment, also physically, also for non-disabled people, on several dimensions (e.g., distances, weights, size, temperature, time). METHODS As unilateral below elbow amputee user, the first author is in a unique position to provide direct comparison of a "bionic" myoelectric iLimb Revolution (Touch Bionics) and a customized body-powered arm which contains a number of new developments initiated or developed by the user: (1) quick lock steel wrist unit; (2) cable mount modification; (3) cast shape modeled shoulder anchor; (4) suspension with a soft double layer liner (Ohio Willowwood) and tube gauze (Molnlycke) combination. The iLimb is mounted on an epoxy socket; a lanyard fixed liner (Ohio Willowwood) contains magnetic electrodes (Liberating Technologies). An on the job usage of five years was supplemented with dedicated and focused intensive two-week use tests at work for both systems. RESULTS The side-by-side comparison showed that the customized body-powered arm provides reliable, comfortable, effective, powerful as well as subtle service with minimal maintenance; most notably, grip reliability, grip force regulation, grip performance, center of balance, component wear down, sweat/temperature independence and skin state are good whereas the iLimb system exhibited a number of relevant serious constraints. CONCLUSIONS Research and development of functional prostheses may want to focus on body-powered technology as it already performs on manually demanding and heavy jobs whereas eliminating myoelectric technology's constraints seems out of reach. Relevant testing could be developed to help expediting this. This is relevant as Swiss disability insurance specifically supports prostheses that enable actual work integration. Myoelectric and cosmetic arm improvement may benefit from a less forgiving focus on perfecting anthropomorphic appearance.
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Affiliation(s)
- Wolf Schweitzer
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190, Zürich, Switzerland.
| | - Michael J Thali
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190, Zürich, Switzerland
| | - David Egger
- Balgrist Tec, Forchstrasse 340, Zürich, Switzerland
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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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