Wendy Hill

Determining skill level in myoelectric prosthesis use with multiple outcome measures

To obtain more insight into how the skill level of an upper-limb myoelectric prosthesis user is composed, the current study aimed to (1) portray prosthetic handling at different levels of description, (2) relate results of the clinical level to kinematic measures, and (3) identify specific parameters in these measures that characterize the skill level of a prosthesis user. Six experienced transradial myoelectric prosthesis users performed a clinical test (Southampton Hand Assessment Procedure [SHAP]) and two grasping tasks. Kinematic measures were end point kinematics, joint angles, grasp force control, and gaze behavior. The results of the clinical and kinematic measures were in broad agreement with each other. Participants who scored higher on the SHAP showed overall better performance on the kinematic measures. They had smaller movement times, had better grip force control, and needed less visual attention on the hand. The results showed that time was a key parameter in prosthesis use and should be one of the main focus aspects of rehabilitation. The insights from this study are useful in rehabilitation practice because they allow therapists to specifically focus on certain parameters that may result in a higher level of skill for the prosthesis user.

Survey of upper limb prosthesis users in Sweden, the United Kingdom and Canada

Background: As part of the process of improving prosthetic arms, it is important to obtain the opinions of the user population. Objectives: To identify factors that should be focused on to improve prosthesis provision. Study design: Postal questionnaire. Methods: The questionnaire was sent to 292 adults (aged 18 to 70 years) with upper-limb loss or absence at five centres (four in Europe) Participants were identified as regular attendees of the centres. Results: This questionnaire received a response from 180 users (response rate 62%) of different types of prosthetic devices. Responses showed that the type of prosthesis generally used was associated with gender, level of loss and use for work (Pearson chi-square, p-values below 0.05). The type of prosthesis was not associated with cause, side, usage (length per day, sports or driving) or reported problems. The findings did not identify any single factor requiring focus for the improvement of prostheses or prosthetic provision. Conclusions: Every part of the process of fitting a prosthesis can be improved, which will have an effect for some of the population who use their devices regularly. There is, however, no single factor that would bring greater improvement to all users. Clinical relevance Based on information gained from a broad range of prosthesis users, no single aspect of prosthetic provision will have a greater impact on the use of upper limb prostheses than any other. Efforts to improve the designs of prosthetic systems can cover any aspect of provision.

Functional Outcomes in the WHO-ICF Model : Establishment of the Upper Limb Prosthetic Outcome Measures Group

A need for a systematic measurement of function for upper limb prosthetics has been identified. Using the World Health Organization-International Classification of Functioning, Disability and Health (WHO-ICF) model, it was clear that no single test was able to cover the entire cycle of prosthetic use from research to application in the field, but it was believed that a unified approach throughout the profession would allow better communication between the contributors to this process. Through a series of meetings, such an approach has been formulated and a special interest group formed that aims to analyze the current literature on the subject, and identify which tools already in existence have the psychometric properties that allow for valid comparison of data between centers and countries. After this analysis, recommendations for a toolkit of different validated tools will be made, along with identifying any gaps within the kit that need additional attention.

Introduction to Assessment

Assessment tools are vital in measuring the outcomes of any practice or procedure. In the development and use of a prosthetic limb, this can be divided into three areas; the basic functions of the design, activities the limb is used for, and the amount the user actually employs the hand in everyday life. Each area is distinct and different and it needs different tools designed specifically for each area in order to reliably measure these outcomes. The development of these tools must include means to make sure the tool measures what the tester thinks it measures and makes sure that such measurements are consistent across time and between testers. Once a consistent set of tools is developed it allows clinicians to discuss and compare devices, training methods and solutions. It also allows investigation of different designs.Currently, the emphasis is on the basic practical measurements of function, activity and participation. This uses simple methods based on observation, timing or questionnaires to measure the use of simple prostheses. With newer designs of multifunction hands and microprocessor controllers being introduced, there are more varied control methods for the different hands. This requires more sophisticated methods to measure the impact of the new designs. These new methods include the measurement of the motions of the body and upper limbs with optical methods, and looking at measuring the cognitive load that controlling such hands impose on the user. To allow simple comparisons between users, the tasks and methods have to be constrained. This creates more artificial activities which may themselves be too artificial to tell the observer what they need to know, so the choice of activity is a balance between realistic tasks and reliable results.Assessment tools are vital in measuring the outcomes of any practice or procedure. In the development and use of a prosthetic limb, this can be divided into three areas; the basic functions of the design, activities the limb is used for, and the amount the user actually employs the hand in everyday life. Each area is distinct and different and it needs different tools designed specifically for each area in order to reliably measure these outcomes. The development of these tools must include means to make sure the tool measures what the tester thinks it measures and makes sure that such measurements are consistent across time and between testers. Once a consistent set of tools is developed it allows clinicians to discuss and compare devices, training methods and solutions. It also allows investigation of different designs. Currently, the emphasis is on the basic practical measurements of function, activity and participation. This uses simple methods based on observation, timing or questionnaires to measure the use of simple prostheses. With newer designs of multifunction hands and microprocessor controllers being introduced, there are more varied control methods for the different hands. This requires more sophisticated methods to measure the impact of the new designs. These new methods include the measurement of the motions of the body and upper limbs with optical methods, and looking at measuring the cognitive load that controlling such hands impose on the user. To allow simple comparisons between users, the tasks and methods have to be constrained. This creates more artificial activities which may themselves be too artificial to tell the observer what they need to know, so the choice of activity is a balance between realistic tasks and reliable results. - See more at: http://eurekaselect.com/103365/chapter/introduction-to-assessmen#sthash.CWvcyTj7.dpuf

Phantom motor execution as a treatment for phantom limb pain: protocol of an international, double-blind, randomised controlled clinical trial

Introduction Phantom limb pain (PLP) is a chronic condition that can greatly diminish quality of life. Control over the phantom limb and exercise of such control have been hypothesised to reverse maladaptive brain changes correlated to PLP. Preliminary investigations have shown that decoding motor volition using myoelectric pattern recognition, while providing real-time feedback via virtual and augmented reality (VR-AR), facilitates phantom motor execution (PME) and reduces PLP. Here we present the study protocol for an international (seven countries), multicentre (nine clinics), double-blind, randomised controlled clinical trial to assess the effectiveness of PME in alleviating PLP. Methods and analysis Sixty-seven subjects suffering from PLP in upper or lower limbs are randomly assigned to PME or phantom motor imagery (PMI) interventions. Subjects allocated to either treatment receive 15 interventions and are exposed to the same VR-AR environments using the same device. The only difference between interventions is whether phantom movements are actually performed (PME) or just imagined (PMI). Complete evaluations are conducted at baseline and at intervention completion, as well as 1, 3 and 6 months later using an intention-to-treat (ITT) approach. Changes in PLP measured using the Pain Rating Index between the first and last session are the primary measure of efficacy. Secondary outcomes include: frequency, duration, quality of pain, intrusion of pain in activities of daily living and sleep, disability associated to pain, pain self-efficacy, frequency of depressed mood, presence of catastrophising thinking, health-related quality of life and clinically significant change as patient’s own impression. Follow-up interviews are conducted up to 6 months after the treatment. Ethics and dissemination The study is performed in agreement with the Declaration of Helsinki and under approval by the governing ethical committees of each participating clinic. The results will be published according to the Consolidated Standards of Reporting Trials guidelines in a peer-reviewed journal. Trial registration number NCT03112928; Pre-results.

Grasping the Future: Advances in Powered Upper Limb Prosthetics

Assessment tools are vital in measuring the outcomes of any practice or procedure. In the development and use of a prosthetic limb, this can be divided into three areas; the basic functions of the design, activities the limb is used for, and the amount the user actually employs the hand in everyday life. Each area is distinct and different and it needs different tools designed specifically for each area in order to reliably measure these outcomes. The development of these tools must include means to make sure the tool measures what the tester thinks it measures and makes sure that such measurements are consistent across time and between testers. Once a consistent set of tools is developed it allows clinicians to discuss and compare devices, training methods and solutions. It also allows investigation of different designs.Currently, the emphasis is on the basic practical measurements of function, activity and participation. This uses simple methods based on observation, timing or questionnaires to measure the use of simple prostheses. With newer designs of multifunction hands and microprocessor controllers being introduced, there are more varied control methods for the different hands. This requires more sophisticated methods to measure the impact of the new designs. These new methods include the measurement of the motions of the body and upper limbs with optical methods, and looking at measuring the cognitive load that controlling such hands impose on the user. To allow simple comparisons between users, the tasks and methods have to be constrained. This creates more artificial activities which may themselves be too artificial to tell the observer what they need to know, so the choice of activity is a balance between realistic tasks and reliable results.Assessment tools are vital in measuring the outcomes of any practice or procedure. In the development and use of a prosthetic limb, this can be divided into three areas; the basic functions of the design, activities the limb is used for, and the amount the user actually employs the hand in everyday life. Each area is distinct and different and it needs different tools designed specifically for each area in order to reliably measure these outcomes. The development of these tools must include means to make sure the tool measures what the tester thinks it measures and makes sure that such measurements are consistent across time and between testers. Once a consistent set of tools is developed it allows clinicians to discuss and compare devices, training methods and solutions. It also allows investigation of different designs. Currently, the emphasis is on the basic practical measurements of function, activity and participation. This uses simple methods based on observation, timing or questionnaires to measure the use of simple prostheses. With newer designs of multifunction hands and microprocessor controllers being introduced, there are more varied control methods for the different hands. This requires more sophisticated methods to measure the impact of the new designs. These new methods include the measurement of the motions of the body and upper limbs with optical methods, and looking at measuring the cognitive load that controlling such hands impose on the user. To allow simple comparisons between users, the tasks and methods have to be constrained. This creates more artificial activities which may themselves be too artificial to tell the observer what they need to know, so the choice of activity is a balance between realistic tasks and reliable results. - See more at: http://eurekaselect.com/103365/chapter/introduction-to-assessmen#sthash.CWvcyTj7.dpuf

Introduction to assessment in Grasping the Future: : Advances in Powered Upper Limb Prosthetics

Assessment tools are vital in measuring the outcomes of any practice or procedure. In the development and use of a prosthetic limb, this can be divided into three areas; the basic functions of the design, activities the limb is used for, and the amount the user actually employs the hand in everyday life. Each area is distinct and different and it needs different tools designed specifically for each area in order to reliably measure these outcomes. The development of these tools must include means to make sure the tool measures what the tester thinks it measures and makes sure that such measurements are consistent across time and between testers. Once a consistent set of tools is developed it allows clinicians to discuss and compare devices, training methods and solutions. It also allows investigation of different designs.Currently, the emphasis is on the basic practical measurements of function, activity and participation. This uses simple methods based on observation, timing or questionnaires to measure the use of simple prostheses. With newer designs of multifunction hands and microprocessor controllers being introduced, there are more varied control methods for the different hands. This requires more sophisticated methods to measure the impact of the new designs. These new methods include the measurement of the motions of the body and upper limbs with optical methods, and looking at measuring the cognitive load that controlling such hands impose on the user. To allow simple comparisons between users, the tasks and methods have to be constrained. This creates more artificial activities which may themselves be too artificial to tell the observer what they need to know, so the choice of activity is a balance between realistic tasks and reliable results.Assessment tools are vital in measuring the outcomes of any practice or procedure. In the development and use of a prosthetic limb, this can be divided into three areas; the basic functions of the design, activities the limb is used for, and the amount the user actually employs the hand in everyday life. Each area is distinct and different and it needs different tools designed specifically for each area in order to reliably measure these outcomes. The development of these tools must include means to make sure the tool measures what the tester thinks it measures and makes sure that such measurements are consistent across time and between testers. Once a consistent set of tools is developed it allows clinicians to discuss and compare devices, training methods and solutions. It also allows investigation of different designs. Currently, the emphasis is on the basic practical measurements of function, activity and participation. This uses simple methods based on observation, timing or questionnaires to measure the use of simple prostheses. With newer designs of multifunction hands and microprocessor controllers being introduced, there are more varied control methods for the different hands. This requires more sophisticated methods to measure the impact of the new designs. These new methods include the measurement of the motions of the body and upper limbs with optical methods, and looking at measuring the cognitive load that controlling such hands impose on the user. To allow simple comparisons between users, the tasks and methods have to be constrained. This creates more artificial activities which may themselves be too artificial to tell the observer what they need to know, so the choice of activity is a balance between realistic tasks and reliable results. - See more at: http://eurekaselect.com/103365/chapter/introduction-to-assessmen#sthash.CWvcyTj7.dpuf