scholarly journals Amputee, clinician, and regulator perspectives on current and prospective upper extremity prosthetic technologies

2020 ◽  
Author(s):  
Julie S Rekant ◽  
Lee E Fisher ◽  
Michael L Boninger ◽  
Robert A Gaunt ◽  
Jennifer Collinger
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Limb Amputation ◽  
Prosthetic Devices ◽  
Protocol Development ◽  
Current State ◽  
Device Reliability ◽  
Task Goals ◽  
Compare And Contrast

Existing prosthetic technologies for people with upper limb amputation are being adopted at moderate rates and unfortunately these devices are often abandoned. The aims of this study were to: 1) understand the current state of satisfaction with upper extremity prostheses, 2) solicit feedback about prosthetic technology and important device design criteria from amputees, clinicians, and device regulators, and 3) compare and contrast these perspectives to identify common or divergent priorities. Twenty-one adults with upper limb loss, 35 clinicians, and 3 regulators completed a survey on existing prosthetic technologies and a conceptual sensorimotor prosthesis driven by implanted myoelectric electrodes with sensory feedback provided via stimulation of dorsal root ganglion. User and clinician ratings of satisfaction with existing prosthetic devices were similar. While amputees, clinicians, and regulators were similarly accepting of technology in general, amputees were most accepting of the proposed implantable sensorimotor prosthesis. Overall, stakeholders valued user-centred outcomes such as individualized task goals, improved quality of life, device reliability, and user safety; a large emphasis was put on these last two outcomes by regulators. The results of this study provide insight into the priorities of amputees, clinicians, and regulators that will inform future upper-limb prosthetic design and clinical trial protocol development.

Neurorehabilitation in Adults With Traumatic Upper Extremity Amputation: A Scoping Review

2021 ◽  
pp. 154596832110702
Author(s):  
Jake Rydland ◽  
Stephanie Spiegel ◽  
Olivia Wolfe ◽  
Bennett Alterman ◽  
John T Johnson ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Current Literature ◽  
Scoping Review ◽  
Neural Mechanisms ◽  
Limb Amputation ◽  
Future Research ◽  
Prosthetic Devices ◽  
Scoping Reviews ◽  
Extremity Amputation

Background Most of the current literature around amputation focuses on lower extremity amputation or engineering aspects of prosthetic devices. There is a need to more clearly understand neurobehavioral mechanisms related to upper extremity amputation and how such mechanisms might influence recovery and utilization of prostheses. Objective This scoping review aims to identify and summarize the current literature on adult traumatic upper limb amputation in regard to recovery and functional outcomes and how neuroplasticity might influence these findings. Methods We identified appropriate articles using Academic Search Complete EBSCO, OVID Medline, and Cochrane databases. The resulting articles were then exported, screened, and reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Results Eleven (11) studies met the study criteria. Of these studies, 7 focused on sensory involvement, 3 focused on neuroplastic changes post-amputation related to functional impact, and 1 study focused on motor control and learning post-amputation. Overall, these studies revealed an incomplete understanding of the neural mechanisms involved in motor rehabilitation in the central and peripheral nervous systems, while also demonstrating the value of an individualized approach to neurorehabilitation in upper limb loss. Conclusions There is a gap in our understanding of the role of neurorehabilitation following amputation. Overall, focused rehabilitation parameters, demographic information, and clarity around central and peripheral neural mechanisms are needed in future research to address neurobehavioral mechanisms to promote functional recovery following traumatic upper extremity amputation.

scholarly journals Unimanual Intensive Therapy with or without Unaffected Hand Containment in Children with Hemiplegia. A Randomized Controlled Pilot Study

2020 ◽  
Vol 9 (9) ◽  
pp. 2992
Author(s):  
Rocío Palomo-Carrión ◽  
Elena Pinero-Pinto ◽  
Sara Ando-LaFuente ◽  
Asunción Ferri-Morales ◽  
Elisabeth Bravo-Esteban ◽  
...  
Keyword(s):  
Pilot Study ◽  
Upper Extremity ◽  
Upper Limb ◽  
Intensive Therapy ◽  
Randomized Controlled ◽  
Upper Limb Function ◽  
Constraint Induced Movement Therapy ◽  
Quality Of Movement ◽  
Quest Scale

Children with hemiplegia have lower spontaneous use and quality of movement in the affected upper limb. The modified constraint-induced movement therapy (mCIMT) is applied to improve the affected upper limb function. The objective of this study was to study the efficacy of unaffected hand containment to obtain changes in the function of the affected upper limb after applying two unimanual therapies. A randomized controlled pilot study was performed with 16 children diagnosed with congenital infantile hemiplegia, with eight children randomized in each group (average age: 5.54 years; SD: 1.55). mCIMT and unimanual therapy without containment (UTWC) were applied, with a total of 50 h distributed in five weeks (two h/per day). Two assessments were performed (pre- and post-treatment) to evaluate the affected upper limb spontaneous use, measured with the Shiners Hospital Upper Extremity Evaluation (SHUEE), and the quality of movement, measured with the Quality of Upper Extremity Skills Test (QUEST scale). The progression of the variables was different in both groups. The results are expressed in the median of the improvement percent and interquartile range (IQR). The spontaneous use analysis showed an improvement percent of 31.65 (IQR: 2.33, 110.42) in the mCIMT group with respect to 0.00 (IQR: 0.00, 0.00) in the UTWC group. The quality of movement increased in the mCIMT and UTWC groups, 24.21 (IQR: 13.44, 50.39), 1.34 (IQR: 0.00, 4.75), respectively and the greatest increase was obtained in the grasp variable for both groups. The use of unaffected hand containment in mCIMT would produce improvements in the affected upper limb functionality in children with hemiplegia (4–8 years old) compared to the same protocol without containment (UTWC).

scholarly journals Upper Extremity Strength Measurement for Children With Cerebral Palsy: A Systematic Review of Available Instruments

2014 ◽  
Vol 94 (5) ◽  
pp. 609-622 ◽  
Author(s):  
Koen J.F.M. Dekkers ◽  
Eugene A.A. Rameckers ◽  
Rob J.E.M. Smeets ◽  
Yvonne J.M. Janssen-Potten
Keyword(s):  
Cerebral Palsy ◽  
Muscle Strength ◽  
Upper Extremity ◽  
Upper Limb ◽  
Measurement Instruments ◽  
Strength Measurement ◽  
Level Of Evidence ◽  
Best Evidence Synthesis ◽  
Children With Cerebral Palsy

Background In order to make inferences about strength related to development or treatment interventions, it is important to use measurement instruments that have sound clinimetric properties. Purpose The objective of this review is to systematically evaluate the level of evidence of the clinimetric properties of instruments for measuring upper extremity muscle strength at the “body functions & structures” level of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) for children with cerebral palsy (CP). Data Sources A systematic search of the PubMed, EMBASE, OTseeker, CINAHL, PEDro, and MEDLINE databases up to November 2012 was performed. Study Selection Two independent raters identified and examined studies that reported the use of upper extremity strength measurement instruments and methods for children and adolescents with CP aged 0 to 18 years. Data Extraction The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist with 4-point rating scale was used by 2 independent raters to evaluate the methodological quality of the included studies. Best evidence synthesis was performed using COSMIN outcomes and the quality of the clinimetric properties. Data Synthesis Six different measurement instruments or methods were identified. Test-retest, interrater, and intrarater reliability were investigated. Two test-retest reliability studies were rated as “fair” for the level of evidence. All other studies were rated as “unknown” for the level of evidence. Limitations The paucity of literature describing clinimetric properties, especially other than reliability, of upper limb strength measurement instruments for children with CP was a limitation of the study. Conclusions For measuring grip strength, the Jamar dynamometer is recommended. For other muscle groups, handheld dynamometry is recommended. Manual muscle testing (MMT) can be used in case of limited (below MMT grade 4) wrist strength or for total upper limb muscle strength. Based on lacking information regarding other clinimetric properties, caution is advised regarding interpretation of the results.

scholarly journals DETERMINANTS OF QUALITY OF LIFE AMONG UPPER LIMB PROSTHESIS USERS PAKISTAN: A MULTICENTER STUDY

2021 ◽  
Vol 71 (6) ◽  
pp. 2037-40
Author(s):  
Faiza Sethi ◽  
Nazia Mumtaz ◽  
Ghulam Saqulain
Keyword(s):  
Quality Of Life ◽  
Upper Extremity ◽  
Upper Limb ◽  
Short Form ◽  
Short Form Health Survey ◽  
Form Health ◽  
Sf 36 ◽  
Quick Dash ◽  
Short Form Health

Objective: To determine the quality of life among users of upper extremity prosthesis. Study Design: Cross sectional study. Place and Duration of Study: Day’s Medical Engineering and Artificial Limbs Center Multan and Pakistan Institute of Prosthetic and Orthotic Sciences, Peshawar, Pakistan, from Jul to Dec 2018. Methodology: A sample population of 276 users of upper extremity prosthesis was recruited employing convenience sampling including both genders aged 20-50 years. Demographic sheet, 36- Item Short Form Health Survey (SF-36) and Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH) were used to collect data followed by analysis using SPSS-22. Results: Mean score on Quick Disabilities of the Arm, Shoulder and Hand questionnaire was 49.2+25.4. The mean scores of 36- Item Short Form Health Survey revealed highest values in the domains of emotional wellbeing (55.8 ± 17.7) and energy/ fatigue (54.0 ± 14.3) while lowest values were noted in the role limitation due to emotional problems (38.9 ± 33.5) and General Health (43.8 ± 19.6) domains. Conclusion: The study findings concluded that the overall quality of life of upper limb prosthetic user was low along with significant association of demographic features with SF-36 and Quick DASH.

scholarly journals Upper extremity function and quality of life in patients with breast cancer related lymphedema

2016 ◽  
Vol 73 (9) ◽  
pp. 825-830 ◽  
Author(s):  
Dragana Bojinovic-Rodic ◽  
Svetlana Popovic-Petrovic ◽  
Sanja Tomic ◽  
Stanislava Markez ◽  
Dobrinka Zivanic
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Mental Health ◽  
Upper Extremity ◽  
Upper Limb ◽  
Limb Function ◽  
Upper Limb Function ◽  
Upper Extremity Function ◽  
Breast Cancer Related Lymphedema

Background/Aim. Upper limb lymphedema is one of the most frequent chronic complications after breast cancer treatment with a significant impact on the upper extremity function and quality of life (QoL). The aim of this study was to estimate health-related quality of life (HRQoL) in patients with breast-cancer-related lymphedema and its correlation with upper limb function and the size of edema. Methods. The cross-sectional study included 54 breast-cancer-related lymphedema patients. The quality of life was evaluated by the Short Form 36-Item Health Survey (SF-36). Upper limb function was assessed by the Quick Disability of the Arm, Shoulder and Hand questionnaire (Quick DASH). The size of lymphedema was determined by the arm circumference. Results. The higher HRQoL score was assessed for mental health (47.0 ? 12.2) than for physical one (42.2 ? 7.5). The highest values of SF-36 were found in the domains of Mental Health (67.7 ? 22.9) and Social Function (70.1 ? 23.1). The lowest scores were registered in the domains of Role Physical (46.9 ? 39.1) and General Health (49.3 ? 20.1). Upper extremity function statistically significantly correlated with the domains Role Physical, Bodily Pain and Physical Composite Summary and also, with the domain Role Emotional (p < 0.01). There was no statistically significant correlation between size of lymphedema and tested domains of quality of life (p > 0.05). Conclusions. Physical disability in patients with breast cancer-related lymphedema influences quality of life more than mental health. Upper limb function has a significant impact on quality of life, not only on the physical, but also on the mental component. The presence of breast-cancer-related lymphedema certainly affects upper limb function and quality of life, but in this study no significant correlation between the size of edema and quality of life was found.

scholarly journals Comparison of the Melbourne Assessment of Unilateral Upper Limb Function and the Quality of Upper Extremity Skills Test in hemiplegic CP

2008 ◽  
Vol 50 (12) ◽  
pp. 904-909 ◽  
Author(s):  
K Klingels ◽  
P De Cock ◽  
K Desloovere ◽  
C Huenaerts ◽  
G Molenaers ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Limb Function ◽  
Upper Limb Function

scholarly journals Application of Low-Intensity Modified Constraint-Induced Movement Therapy to Improve the Affected Upper Limb Functionality in Infantile Hemiplegia with Moderate Manual Ability: Case Series

Children ◽  
2020 ◽  
Vol 7 (9) ◽  
pp. 127
Author(s):  
Rocío Palomo-Carrión ◽  
Rita-Pilar Romero-Galisteo ◽  
Elena Pinero-Pinto ◽  
Purificación López-Muñoz ◽  
Helena Romay-Barrero ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Case Series ◽  
Movement Therapy ◽  
Low Intensity ◽  
Constraint Induced Movement Therapy ◽  
Case Series Study ◽  
Quality Of Movement ◽  
Pre Treatment

Objective: To assess the functionality of the affected upper limb in children diagnosed with hemiplegia aged between 4 and 8 years after applying low-intensity modified Constraint-Induced Movement Therapy (mCIMT). Methods: Prospective case series study. A mCIMT protocol was applied for five weeks, with two hours of containment per day. The study variables were quality of movement of the upper limb, spontaneous use, participation of the affected upper limb in activities of daily living, dynamic joint position, grasp–release action, grasp strength, supination and extension elbow movements. Four measurements were performed, using the quality of upper extremity test (QUEST) scale, the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) Evaluation, a hand dynamometer and a goniometer. Results: The sample was composed of eight children with moderate manual ability. Statistically significant differences were detected in all the studied variables (p < 0.05) between the pre-treatment and post–treatment results (Week 0–Week 5), except for upper limb dressing, putting on splints and buttoning up. In the first week, the changes were statistically significant, except for protective extension, grasp strength, grasp–release and all functional variables (level of functionality and participation of the patient’s upper limbs) in the SHUEE Evaluation (p > 0.05). The greatest increase occurred in spontaneous use from Assessment 1 to Assessment 4 (p = 0.01), reaching 88.87% active participation in bimanual tasks. The quality of movement of the upper limb exhibited a significant value due to the increase in dissociated movements and grasp (p = 0.01). Conclusion: A low dose (50 h) of mCIMT increased the functionality of children diagnosed with congenital hemiplegia between 4 and 8 years of age with moderate manual ability.

scholarly journals Movement quality of conventional prostheses and the DEKA Arm during everyday tasks

2016 ◽  
Vol 41 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Jeffrey Cowley ◽  
Linda Resnik ◽  
Jason Wilken ◽  
Lisa Smurr Walters ◽  
Deanna Gates
Keyword(s):  
Upper Limb ◽  
Wrist Joint ◽  
Case Series ◽  
Prosthetic Devices ◽  
Movement Quality ◽  
Prosthetic Limb ◽  
Upper Limb Prosthesis ◽  
Quantitative Analyses ◽  
Joint Center

Background:Conventional prosthetic devices fail to restore the function and characteristic movement quality of the upper limb. The DEKA Arm is a new, advanced prosthesis featuring a compound, powered wrist and multiple grip configurations.Objectives:The purpose of this study was to determine if the DEKA Arm improved the movement quality of upper limb prosthesis users compared to conventional prostheses.Study design:Case series.Methods:Three people with transradial amputation completed tasks of daily life with their conventional prosthesis and with the DEKA Arm. A total of 10 healthy controls completed the same tasks. The trajectory of the wrist joint center was analyzed to determine how different prostheses affected movement duration, speed, smoothness, and curvature compared to patients’ own intact limbs and controls.Results:Movement quality decreased with the DEKA Arm for two participants, and increased for the third. Prosthesis users made slower, less smooth, more curved movements with the prosthetic limb compared to the intact limb and controls, particularly when grasping and manipulating objects.Conclusion:The effects of one month of training with the DEKA Arm on movement quality varied with participants’ skill and experience with conventional prostheses. Future studies should examine changes in movement quality after long-term use of advanced prostheses.Clinical relevanceMovement quality with the DEKA Arm may depend on the user’s previous experience with conventional prostheses. Quantitative analyses are needed to assess the efficacy of novel prosthetic devices and to better understand how to train people to use them effectively.

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