The social and economic outcome after upper limb amputation

Embedded Machine Learning System for Muscle Patterns Detection in a Patient with Shoulder Disarticulation

The integration of artificial intelligence (AI) models in the classification of electromyographic (EMG) signals represents a significant advancement in the design of control systems for prostheses. This study explores the development of a portable system that classifies the electrical activity of three shoulder muscles in real time for actuator control, marking a milestone in the autonomy of prosthetic devices. Utilizing low-power microcontrollers, the system ensures continuous EMG signal recording, enhancing user mobility. Focusing on a case study-a 42-year-old man with left shoulder disarticulation-EMG activity was recorded over two days using a specifically designed electronic board. Data processing was performed using the Edge Impulse platform, renowned for its effectiveness in implementing AI on edge devices. The first day was dedicated to a training session with 150 repetitions spread across 30 trials and three different movements. Based on these data, the second day tested the AI model's ability to classify EMG signals in new movement executions in real time. The results demonstrate the potential of portable AI-based systems for prosthetic control, offering accurate and swift EMG signal classification that enhances prosthetic user functionality and experience. This study not only underscores the feasibility of real-time EMG signal classification but also paves the way for future research on practical applications and improvements in the quality of life for prosthetic users.

Systematic Review and Meta-Analysis of Global Neuroma Incidence in Upper Extremity Amputees

BACKGROUND

Neuromas substantially decrease a patient's quality of life and obstruct the use of prosthetics. This systematic review and meta-analysis aimed to determine the global incidence of neuroma formation in upper extremity amputees.

METHODS

A literature search was performed using 3 databases: Web of Science, MEDLINE, and Cochrane. Inclusion criteria for the systematic review were those studies investigating only upper extremity amputees and reported postamputation neuroma. A random-effects, inverse-variance analysis was conducted to determine the pooled proportion of neuromas within the upper extremity amputation population. Critical appraisal using the JBI Checklist for Studies Reporting Prevalence Data of each individual article were performed for the systematic review.

RESULTS

Eleven studies met the inclusion criteria collating a total of 1931 patients across 8 countries. More than three-fourth of patients are young men (77%; age range, 19-54 years) and had an amputation due to trauma. The random-effects analysis found the pooled combined proportion of neuromas to be 13% (95% confidence interval, 8%-18%). The treatment of neuroma is highly variable, with some patients receiving no treatment.

CONCLUSIONS

The pooled proportion of neuroma incidence in the 1931 patients was 13%. With the known global prevalence of upper extremity amputees, this translates to nearly 3 million amputees suffering from a neuroma globally. Increasing training in preventative surgical methods could contribute to lowering this incidence and improving the outcomes of this patient population.

Technological Advances in Prosthesis Design and Rehabilitation Following Upper Extremity Limb Loss

PURPOSE OF REVIEW

The complexity of the human extremity, particularly the upper extremity and the hand, allows us to interact with the world. Prosthetists have struggled to recreate the intuitive motor control, light touch sensation, and proprioception of the innate limb in a manner that reflects the complexity of its native form and function. Nevertheless, recent advances in prosthesis technology, surgical innovations, and enhanced rehabilitation appear promising for patients with limb loss who hope to return to their pre-injury level of function. The purpose of this review is to illustrate recent technological advances that are moving us one step closer to the goal of multi-functional, self-identifiable, durable, and intuitive prostheses.

RECENT FINDINGS

Surgical advances such as targeted muscle reinnervation, regenerative peripheral nerve interfaces, agonist-antagonist myoneural interfaces, and targeted sensory reinnervation; development of technology designed to restore sensation, such as implanted sensors and haptic devices; and evolution of osseointegrated (bone-anchored) prostheses show great promise. Augmented and virtual reality platforms have the potential to enhance prosthesis design, pre-prosthetic training, incorporation, and use. Emerging technologies move surgeons, rehabilitation physicians, therapists, and prosthetists closer to the goal of creating highly functional prostheses with elevated sensory and motor control. Collaboration between medical teams, scientists, and industry stakeholders will be required to keep pace with patients who require durable, high-functioning prostheses.

Evoking haptic sensations in the foot through high-density transcutaneous electrical nerve stimulations

OBJECTIVE

Evoking haptic sensation on upper limb amputees via peripheral nerve stimulation has been investigated intensively in the past decade, but related studies involving lower limb amputees are limited. This study aimed to evaluate the feasibility of using non-invasive transcutaneous electrical nerve stimulation to evoke haptic sensation along the phantom limb of the amputated foot of transtibial amputees.

APPROACH

A high-density electrode grid (4 × 4) was placed over the skin surface above the distal branching of the sciatic, tibial, and common peroneal nerves. We hypothesized that electrical stimulation delivered to distinct electrode pairs created unique electric fields, which can activate selective sets of sensory axons innervating different skin regions of the foot. Five transtibial amputee subjects (three unilateral and two bilateral) and one able-bodied subject were tested by scanning all possible electrode pair combinations.

MAIN RESULTS

All subjects reported various haptic percepts at distinct regions along the foot with each corresponding to specific electrode pairs. These results demonstrated the capability of our non-invasive nerve stimulation method to evoke haptic sensations in the foot of transtibial amputees and the able-bodied subject.

SIGNIFICANCE

The outcomes contribute important knowledge and evidence regarding missing tactile sensation in the foot of lower limb amputees and might also facilitate future development of strategies to manage phantom pain and enhance embodiment of prosthetic legs in the future.

Assessment of sexual function and quality of life in patients with lower limb amputations

BACKGROUND

Diseases causing disabilities lead to sexual dysfunction. However, studies that evaluate sexual functions in patients with traumatic lower limb amputations (LLA) are limited and controversial.

OBJECTIVE

The objective is to evaluate sexual functions in male patients with LLA and to identify factors that might contribute to sexual dysfunction. The hypothesis is that male patients with LLA would experience worse sexual and emotional functioning and consequently emotional impairment that consequently influenced the sexual function.

METHODS

Sixty men with traumatic LLA and 60 healthy men were assessed according to the International Index of Erectile Function (IIEF) scoring system. Emotional state was assessed by the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and the quality of life by the Short Form-36 Health Survey (SF-36).

RESULTS

Patients had significantly lower scores in the IIEF total score and subscores in comparison with the controls. Intercourse satisfaction scores were significantly higher (p< 0.05) in patients with trans-tibial amputation than in those with trans-femoral amputation. BDI and BAI scores negatively correlated with erectile function, sexual desire, intercourse satisfaction, overall satisfaction and total IIEF scores. The mental and physical scores of SF-36 significantly correlated with some of the sub scores and IIEF total scores. The power of statistical analysis for study population was 100% according to the given effect size (α= 0.01).

CONCLUSION

The present study suggests that the LLA leads to impairments in the sexual function and quality of life in male patients. Also, sexual dysfunction in patients is strongly associated with emotional state, pain, level of amputation and quality of life.

Discrimination and Recognition of Phantom Finger Sensation Through Transcutaneous Electrical Nerve Stimulation

Tactile sensory feedback would make a significant contribution to the state-of-the-art prosthetic hands for achieving dexterous manipulation over objects. Phantom finger sensation, also called referred sensation of lost fingers, can be noninvasively evoked by transcutaneous electrical nerve stimulation (TENS) of the phantom finger territories (PFTs) near the stump for upper-limb amputees. As such, intuitive sensations pertaining to lost fingers could be non-invasively generated. However, the encoding of stimulation parameters into tactile sensations that can be intuitively interpreted by the users remains a significant challenge. Further, how discriminative such artificial tactile sensation with TENS of the PFTs is still unknown. In this study, we systematically characterized the tactile discrimination across different phantom fingers on the stump skin by TENS among six subjects. Charge-balanced and biphasic stimulating current pulses were adopted. The pulse amplitude (PA), the pulse frequency (PF) and the pulse width (PW) were modulated to evaluate the detection threshold, perceived touch intensity, and the just-noticeable difference (JND) of the phantom finger sensation. Particularly, the recognition of phantom fingers under simultaneous stimulation was assessed. The psychophysical experiments revealed that subjects could discern fine variations of stimuli with comfortable sensation of phantom fingers including D1 (phantom thumb), D2 (phantom index finger), D3 (Phantom middle finger), and D5 (Phantom pinky finger). With respect to PA, PF, and PW modulations, the detection thresholds across the four phantom fingers were achieved by the method of constant stimuli based on a two-alternative forced-choice (2AFC) paradigm. For each modulation, the perceived intensity, which was indexed by skin indentations on the contralateral intact finger pulp, reinforced gradually with enhancing stimuli within lower-intensity range. Particularly, the curve of the indentation depth vs. PF almost reached a plateau with PF more than 200 Hz. Moreover, the performance of phantom finger recognition deteriorated with the increasing number of phantom fingers under simultaneous TENS. For one, two and four stimulating channels, the corresponding recognition rate of an individual PFT were respective 85.83, 67.67, and 46.44%. The results of the present work would provide direct guidelines regarding the optimization of stimulating strategies to deliver artificial tactile sensation by TENS for clinical applications.

Design and Development of a Novel Upper-Limb Cycling Prosthesis

The rise in popularity of the Paralympics in recent years has created a need for effective, low-cost sports-prosthetic devices for upper-limb amputees. There are various opportunities for lower-limb amputees to participate in cycling; however, there are only few options for those with upper-limb amputations. If the individual previously participated in cycling, a cycling-specific prosthesis could allow these activities to be integrated into rehabilitation methods. This article describes the processes involved with designing, developing and manufacturing such a prosthesis. The fundamental needs of people with upper-limb amputation were assessed and realised in the prototype of a transradial terminal device with two release mechanisms, including a sliding mechanism (for falls and minor collisions) and clamping mechanism (for head-on collisions). The sliding mechanism requires the rider to exert approximately 200 N, while the clamping mechanism requires about 700 N. The force ranges can be customised to match rider requirements. Experiments were conducted in a controlled environment to demonstrate stability of the device during normal cycling. Moreover, a volunteer test-rider was able to successfully activate the release mechanism during a simulated emergency scenario. The development of this prosthesis has the potential to enable traumatic upper-limb amputees to participate in cycling for rehabilitation or recreation.

Health-related quality of life in adults with congenital unilateral upper limb deficiency in Norway. A cross-sectional study

PURPOSE

To examine subjective health-related quality of life (HRQoL) in adults with congenital unilateral upper limb deficiency (UULD) in Norway and to explore the associations between demographic and clinical factors and HRQoL.

METHOD

Cross-sectional study comparing HRQoL, measured by SF-36, among adults with UULD and an age- and gender-matched control group from the Norwegian general population (NGP).

RESULTS

Seventy-seven respondents, median age 42 years (range: 20-82); 71% were women. Most had left-sided (61%), below elbow (53%), transverse (73%) deficiency. Compared to the NGP, the UULD group reported reduced HRQoL on all SF-36 subscales except for the role emotional (RE) scale (p=0.321), mental health (MH) (p=0.055) and mental component summary (MCS) (p=0.064). The greatest difference was on the bodily pain (BP) scale (point difference of 20.0). Multiple linear regression models showed significant association between several physical- and mental SF-36 subscales and occupational status, occurrence of comorbidity and chronic pain.

CONCLUSIONS

Persons with UULD reported reduced HRQoL on most SF-36 subscales, mostly in the physical health domain. Employment status, occurrence of comorbidity and chronic pain seem to have a negative impact on the HRQoL. Measures that can reduce pain and loss of function should be given particular attention in UULD rehabilitation. Implications for Rehabilitation Persons with congenital unilateral upper limb deficiency (UULD) who experience pain and discomfort should seek professional help for evaluating their everyday coping strategies. Professionals who meet persons with UULD should examine anomalies, comorbidity, pain and employment status before choosing advices and actions. Individually adapted grip-improving devices, environments, physical exercise and pain management programs should be implemented early to reduce pain, loss of function and decreased HRQoL. A multidisciplinary approach is often necessary when counseling persons with UULD.

Upper Limb Absence: Predictors of Work Participation and Work Productivity

OBJECTIVES

To analyze work participation, work productivity, contributing factors, and physical work demands of individuals with upper limb absence (ULA).

DESIGN

Cross-sectional study: postal survey (response rate, 45%).

SETTING

Twelve rehabilitation centers and orthopedic workshops.

PARTICIPANTS

Individuals (n=207) with unilateral transverse upper limb reduction deficiency (RD) or acquired amputation (AA), at or proximal to the carpal level, between the ages of 18 and 65 years, and a convenience sample of control subjects (n=90) matched on age and sex.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Employment status, self-reported work productivity measured with the Quality-Quantity method, and self-reported upper extremity work demands measured with the Upper Extremity Work Demands scale.

RESULTS

Seventy-four percent of the individuals with RD and 57% of the individuals with AA were employed (vs 82% of the control group and 66% of the general population). Male sex, younger age, a medium or higher level of education, prosthesis use, and good general health were predictors of work participation. Work productivity was similar to that of the control group. Higher work productivity was inversely related to musculoskeletal complaint-related pain. When having predominantly mentally demanding work, individuals with ULA perceived higher upper extremity work demands compared with controls.

CONCLUSIONS

Work participation of individuals with RD was slightly higher compared with that of the general population, whereas employment rates of individuals with AA were slightly lower. Furthermore, work productivity did not differ between individuals with RD, AA, and controls.

Engineered composite tissue as a bioartificial limb graft

The loss of an extremity is a disastrous injury with tremendous impact on a patient's life. Current mechanical prostheses are technically highly sophisticated, but only partially replace physiologic function and aesthetic appearance. As a biologic alternative, approximately 70 patients have undergone allogeneic hand transplantation to date worldwide. While outcomes are favorable, risks and side effects of transplantation and long-term immunosuppression pose a significant ethical dilemma. An autologous, bio-artificial graft based on native extracellular matrix and patient derived cells could be produced on demand and would not require immunosuppression after transplantation. To create such a graft, we decellularized rat and primate forearms by detergent perfusion and yielded acellular scaffolds with preserved composite architecture. We then repopulated muscle and vasculature with cells of appropriate phenotypes, and matured the composite tissue in a perfusion bioreactor under electrical stimulation in vitro. After confirmation of composite tissue formation, we transplanted the resulting bio-composite grafts to confirm perfusion in vivo.

Prosthesis use in adult acquired major upper-limb amputees: patterns of wear, prosthetic skills and the actual use of prostheses in activities of daily life

PURPOSE

To describe patterns of prosthesis wear and perceived prosthetic usefulness in adult acquired upper-limb amputees (ULAs). To describe prosthetic skills in activities of daily life (ADL) and the actual use of prostheses in the performance of ADL tasks. To estimate the influence of prosthetic skills on actual prosthesis use and the influence of background factors on prosthetic skills and actual prosthesis use.

METHOD

Cross-sectional study analysing population-based questionnaire data (n = 224) and data from interviews and clinical testing in a referred/convenience sample of prosthesis-wearing ULAs (n = 50). Effects were analysed using linear regression.

RESULTS

80.8% wore prostheses. 90.3% reported their most worn prosthesis as useful. Prosthetic usefulness profiles varied with prosthetic type. Despite demonstrating good prosthetic skills, the amputees reported actual prosthesis use in only about half of the ADL tasks performed in everyday life. In unilateral amputees, increased actual use was associated with sufficient prosthetic training and with the use of myoelectric vs cosmetic prostheses, regardless of amputation level. Prosthetic skills did not affect actual prosthesis use. No background factors showed significant effect on prosthetic skills.

CONCLUSIONS

Most major ULAs wear prostheses. Individualised prosthetic training and fitting of myoelectric rather than passive prostheses may increase actual prosthesis use in ADL.

Prosthesis rejection in acquired major upper-limb amputees: a population-based survey

PURPOSE

To estimate the rates of primary and secondary prosthesis rejection in acquired major upper-limb amputees (ULAs), to describe the most frequently reported reasons for rejection and to estimate the influence of background factors on the risk of rejection.

METHOD

Cross-sectional study analysing population-based questionnaire data (n = 224). Effects were analysed by logistic regression analyses and Cox regression analyses.

RESULTS

Primary prosthesis rejection was found in 4.5% whereas 13.4% had discontinued prosthesis use. The main reasons reported for primary non-wear were a perceived lack of need and discrepancies between perceived need and the prostheses available. The main reasons reported for secondary prosthesis rejection were dissatisfaction with prosthetic comfort, function and control. Primary prosthesis rejection was more likely in ULAs amputated at high age and in ULAs with proximal amputations. Secondary prosthesis rejection was more likely in proximal ULAs and in women.

CONCLUSIONS

Clinicians should be aware of the increased risk of rejection in proximal ULAs, elderly ULAs and in women. Emphasising individual needs will probably facilitate successful prosthetic fitting. Improved prosthesis quality and individualised prosthetic training may increase long-term prosthesis use. Further studies of the effect of prosthetic training and of the reasons for rejection of different prosthetic types are suggested.

Partial hand amputation and work

PURPOSE

To determine whether or not subjects who had had a partial hand amputation were able to return to the same job and whether or not they used their silicone finger prosthesis for work.

METHOD

Medical records of all the patients who had undergone a traumatic partial hand amputation and who had been treated in the Upper Limb Prosthetic Clinic at the Institute for Rehabilitation in Ljubljana were reviewed. Questionnaires were sent to 112 patients. Forty-eight questionnaires which were returned and had been correctly answered were analysed.

RESULTS

The study found that less than half the patients who had had a partial hand amputation were able to do the same work as before the amputation. Less than one-third wore their silicone prosthesis at work regularly. The subjects who did not have manual jobs and who had an amputation of only one or two fingers were able to keep the same job more easily after the amputation. Only a few subjects found their silicone prosthesis useful at work.

CONCLUSION

It can be concluded that partial hand amputation may present a great problem in keeping the same job after amputation. An aesthetic (cosmetic) silicone prosthesis is helpful particularly for subjects with higher education whose work involves personal contacts and for whom aesthetics is important. They use the prosthesis for certain activities, such as typing.

Sexuality and amputation: a systematic literature review

PURPOSE

To systematically examine the state of research on sexuality and amputees.

METHODS

A total of five publication databases were searched: Pubmed, Cinahl, Embase, Psychinfo and Recall.

RESULTS

A total of 11 eligible studies was found. The studies were characterised by a diversity of study populations, sampling methods, gender and age distributions, assessment methods, and outcomes measures. The use of the terminology regarding sexuality was ambiguous. All studies found an impact of the amputation of a limb on some part of sexual functioning (or concerns about) to some degree.

CONCLUSIONS

Studies on sexuality and amputees are very diverse and terminology is ambiguous. Amputation of a limb has an impact on sexual functioning. Amputees complain that there is little support from professionals. The authors recommend the use of the ICF terminology. Suggestions for future research are given.

Developing Core Sets for persons following amputation based on the International Classification of Functioning, Disability and Health as a way to specify functioning

Amputation is a common late stage sequel of peripheral vascular disease and diabetes or a sequel of accidental trauma, civil unrest and landmines. The functional impairments affect many facets of life including but not limited to: Mobility; activities of daily living; body image and sexuality. Classification, measurement and comparison of the consequences of amputations has been impeded by the limited availability of internationally, multiculturally standardized instruments in the amputee setting. The introduction of the International Classification of Functioning, Disability and Health (ICF) by the World Health Assembly in May 2001 provides a globally accepted framework and classification system to describe, assess and compare function and disability. In order to facilitate the use of the ICF in everyday clinical practice and research, ICF core sets have been developed that focus on specific aspects of function typically associated with a particular disability. The objective of this paper is to outline the development process for the ICF core sets for persons following amputation. The ICF core sets are designed to translate the benefits of the ICF into clinical routine. The ICF core sets will be defined at a Consensus conference which will integrate evidence from preparatory studies, namely: (a) a systematic literature review regarding the outcome measures of clinical trails and observational studies, (b) semi-structured patient interviews, (c) international experts participating in an internet-based survey, and (d) cross-sectional, multi-center studies for clinical applicability. To validate the ICF core sets field-testing will follow. Invitation for participation: The development of ICF Core Sets is an inclusive and open process. Anyone who wishes to actively participate in this process is invited to do so.

Job adjustments, job satisfaction and health experience in upper and lower limb amputees

OBJECTIVES

To explore job adjustments, job satisfaction, and health experience among employees with an upper limb amputation and to compare the results with those of lower limb amputees and control subjects.

METHODS

Amputees were recruited from data files of a large European University Medical Centre and orthopaedic workshops. Controls were matched colleagues of the lower limb amputees. All participants filled out the VAG questionnaire (Vragenlijst Arbeid en Gezondheid), assessing job satisfaction and job adjustments, and the RAND-36.

RESULTS

28 upper limb amputees were compared to 144 lower limb amputees and 144 controls. Job adjustments were necessary in 38% and 28% of upper and lower limb amputees, respectively. All three groups were equally satisfied with their jobs (p = 0.90). Vocational rehabilitation was applied to 26% and 8% of upper and lower limb amputees, respectively. Upper limb amputees rated their general health worse (18 points, 95% CI: 12-25) compared to lower limb amputees, corrected for effects of confounders (age and co-morbidity).

CONCLUSIONS

Upper and lower limb amputees have high job satisfaction and a minority need job adjustments. In upper limb amputees, the causes of the worrisome general health experience need further investigation. In upper and lower limb amputees, vocational rehabilitation deserves additional attention.

Social integration of juvenile amputees: comparison with a general population

The objective was to assess the social integration of juvenile amputees according to marital status, schooling and occupation, and to compare it with the population of Asturias, Spain. A retrospective study was carried out of the juvenile amputees registered from 1976 to 1999 at the Prosthetics Unit of the Asturias Central Hospital (n=281 amputees). The proportion of single women amongst the amputees was greater than in the population of Asturias (p<0.05). Amongst the male amputees, relative to the general population, there was a larger proportion of the group with primary studies (p<0.001) and a smaller proportion with secondary studies (p<0.001). At the higher level (university) there were no differences, either in men or in women. As regards occupation, amongst the amputees a larger number was found who were retired or unemployed (p<0.05 and p<0.001). In conclusion, juvenile amputees do not show differences compared to the general population with regard to their attendance at a higher or university level of education. However, if their social integration is considered through occupation, male amputees show a greater proportion of unemployment, which is a clear reflection of their handicap.

A survey of the satisfaction of upper limb amputees with their prostheses, their lifestyles, and their abilities

Seventy Australian upper limb amputees responded to a detailed postal questionnaire asking how often they wore their prostheses and their level of satisfaction with both their prostheses and their functional abilities. Fifty-six percent of amputees wore their limbs "once in a while" or "never." Prostheses were most often worn "all the time" for work and social activities. The amount of time amputees wore their prostheses was moderately associated with their level of satisfaction with their prostheses. The association between the amount of time amputees wore their prostheses and their level of satisfaction with their functional abilities was very low. Their prostheses were rated as "fair" or "not acceptable" by 64% of amputees. Sweating was rated as "not acceptable" by 55%. This may well be a significant contributing factor to the low prosthetic use. The amputees who did not wear prostheses did not have any greater satisfaction with their ability to do the tasks they want to do than the amputees who wore prostheses.

Factors conditioning the return to work of upper limb amputees in Asturias, Spain

Reintegration into a social and work environment, as the final objective rehabilitation therapy, is one of the greatest challenges faced in this speciality. The aim of this study was to analyse the reintegration into the workforce of 43 upperlimb amputees in Asturias, Spain (1,100,000 inhabitants) whose amputations were as a result of accidents at work. For this purpose various factors related to their return to work were studied. The most important factor was the year in which the amputation was carried out, since reintegration was more likely to occur in those amputees whose accident at work took place before the 1980s.

The long-term outcome of upper limb amputees treated at a rehabilitation centre in Sydney, Australia

A follow-up study by questionnaire or interview has been made of the 27 respondents of 41 upper limb amputees (66%) treated at the Royal South Sydney Hospital between 1981 and 1990. Prosthetic use of 8 h/day or more was 37% and occasional use was 18.5%. The prosthetic users were more likely to be distal amputees. The reason for the low level of prosthetic use is not known. The majority of non-users discarded prostheses after leaving their rehabilitation programme. Occupational changes were made by 72% of the amputees. The unemployment rate at follow-up was similar to the rest of the community, which is a better outcome than 25 years ago. Activities of daily living had been affected in all patients, but to a lesser extent in prosthetic users. Leisure pursuits were changed in 70% of patients, with these activities being more sedentary and indoor in nature. Of the 18 car drivers, 15 drove automatic cars with modifications. Phantom pain was experienced by 16 of the respondents (59%) and stump pain was experienced by seven. Only 26% used medication or alcohol for the pain. Pain did not affect prosthetic use or functional ability.

Upper limb prosthetic use in Slovenia

The article deals with the use of different types of upper limb prostheses in Slovenia. Four hundred and fourteen upper limb amputees were sent a questionnaire on the type of their prosthesis, its use and reasons for non-use, respectively. The replies were subject to statistical analysis. Most of the questioned upper limb amputees (70%) wear a prosthesis only for cosmesis. The use of a prosthesis depends on the level of upper limb amputation, loss of the dominant hand, and time from amputation. Prosthetic success appears to be unrelated to age at the time of amputation and the rehabilitation programme. The most frequent reason for not wearing a prosthesis is heat and consequent sweating of the stump. More than a third of amputees are dissatisfied with their prostheses.

Consumer concerns and the functional value of prostheses to upper limb amputees

This paper reports a study of 66 upper limb amputees in County Funen, Denmark who were visited in their homes by the author. The purpose of the study was to evaluate the consumer concerns about their prostheses and to see if these were related to cessation of prosthetic use. It was also intended to estimate functional levels of both prosthetic users and non-users. The number of amputees investigated corresponds to the annual number of persons becoming upper limb amputees in Denmark. There were 3 prosthetic systems in use, two active systems and one passive system. At review there was a group of 18 amputees which did not use a prosthesis at all. It appeared that active and partially active users are younger persons with a relatively short time-lapse since amputation. Passive users are older persons with a long time-lapse since amputation. Only 4 out of 18 prosthetic non-users stopped prosthetic use as a consequence of prosthetic problems or discomfort. Active prostheses had the highest number of consumer problems. Most problems were concerned with the socket, and for the body powered prostheses also with the suspension and control system. It was shown that an awareness of the amputee's working conditions is important at the fitting stage, especially the daily working situation. As a consequence strictly individual fitting is needed with attention being given to the manner in which the individual will use the prosthesis. This investigation clearly shows that active fitting is a worthy effort. In daily living the active users have a superior performance over the passive and non-users. It was observed that amputees despite many years of training still have problems with activities of daily living, particularly in relation to independent functions.