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The majority of amputees in this study expressed a desire to receive the DEKA Arm, a device which provides multiple powered degrees of freedom and is operated predominantly by foot controls. The majority reported functional advantages of the DEKA Arm over their existing prostheses.

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Abstract-Mechanical properties of the DEKA Arm and associated engineering innovations are easy to observe. What is less clear is how these advances translate into functional benefits for the user with amputation. Study aims were to (1) quantify outcomes including dexterity, performance of daily activities, and prosthetic skill and spontaneity of users of the DEKA Arm and (2) compare outcomes when using the DEKA Arm with scores using the existing prosthesis. This was a quasi-experimental study. Descriptive analyses examined outcomes by DEKA Arm configuration level. Of the 39 subjects fit with a DEKA Arm, 32 were trained in use and completed end-of-study testing. Data from 26 prosthetic users were used to compare outcomes using existing prostheses with outcomes with the DEKA Arm. Dexterity and activity performance with the DEKA Arm varied by amputation level (p < 0.01). Self-reported function and number of activities performed using the prosthesis were similar across levels. Comparisons with existing prostheses showed the effect on dexterity varied by level. Activity performance and spontaneity of prosthetic use improved for users of the shoulder configuration level, while use of the prosthesis to perform activities and perceived difficulty performing self-selected tasks improved for all levels.

Purpose: We present five cases of adult females with major limb amputations, their concerns and preferences for services across the life span. Design: A convenience sample of five veteran and nonveteran women aged 19-58 with major limb amputations participating in a regional VA Prosthetics Conference in 2010 took part in a panel interview. Findings: The concerns identified by these women as high priorities included independence and participation in a full range of life activities, limitations in access, patient decision-making and body image concerns, and preferences for selected services. Maximizing function and quality of life for women amputees requires identifying patient preferences for rehabilitation and prosthetic services. Lessons learned could inform development of clinic-based rehabilitation care, prosthetic services, and studies of women with major limb amputations. Conclusions: As the current conflicts in Iraq and Afghanistan wind down, the number of women veterans seeking rehabilitation and prosthetic services will increase. With this information, rehabilitation and prosthetic service providers and organizations will be uniquely positioned to provide prevention and treatment of amputations for this growing population of women veterans in national care delivery systems and in communities. Clinical Relevance: An open-ended facilitated discussion among a panel of women with major limb amputations provided insights for providers and organizations with respect to needs, concerns, and preferences for rehabilitation and prosthetic services. Background and Significance

IntroductionEMG pattern recognition control (EMG-PR) is a promising option for control of upper limb prostheses with multiple degrees of freedom (DOF). The purposes of this study were to 1) evaluate outcomes of EMG-PR and inertial measurement units (IMU) control of the DEKA Arm as compared to personal prosthesis; and 2) compare outcomes of EMG-PR to IMU control of DEKA Arm.MethodsThis was a quasi-experimental, multi-site study with repeated measures that compared non-randomized groups using two types of controls: EMG-PR and IMUs. Subjects (N = 36) were transradial (TR) and transhumeral (TH) amputees. Outcomes were collected at Baseline (using personal prosthesis), and after in-laboratory training (Part A), and home use (Part B). Data was compared to personal prosthesis, stratified by amputation level and control type. Outcomes were also compared by control type.ResultsThe EMG-PR group had greater prosthesis use after Part A, but worse dexterity, lower satisfaction, and slower activity performance compared to Baseline; the IMU group had slower activity performance. After Part B, the EMG-PR group had less perceived activity difficulty; the IMU group had improved activity performance, improved disability and activity difficulty, but slower performance. No differences were observed for TH group by control type in Part A or B. The TR group using EMG-PR had worse dexterity (Parts A & B), and activity performance (Part A) as compared to IMU users.Discussion/ConclusionFindings suggest that for the TR group that IMUs are a more effective control method for the DEKA Arm as compared to the EMG-PR prototypes employed in this study. Further research is needed to refine the EMG-PR systems for multi-DOF devices. Future studies should include a larger sample of TH amputees.Trial registrationClinicalTrials.gov NCT01551420.

Endpoint control is a new control strategy for upper-limb prostheses featuring powered shoulders, which aims to reduce the user's cognitive workload, simplify user control, and allow a more natural movement pattern. The user is able to produce coordinated, multijoint movements for positioning the terminal device in space, without directly controlling each joint individually. There have been a number of published studies on endpoint control strategies as these apply to prostheses. However, none have been performed in a clinical setting. This article discusses existing prosthetic control schemes and the theory of endpoint control in robotics and motor controls, provides a case example from the Tampa site of the Department of Veterans Affairs (VA) Study to Optimize the DEKA Arm, and discusses challenges to its use and development. Endpoint control is a useful method to control advanced multiYdegree of freedom (DOF) upper-limb prostheses. (J Prosthet Orthot. 2013;25:193Y200.)

The DEKA Arm has multiple degrees of freedom which historically have been operated primarily by inertial measurement units (IMUs). However, the IMUs are not appropriate for all potential users; new control methods are needed. The purposes of this study were: 1) to describe usability and satisfaction of two controls methods—IMU and myoelectric pattern recognition (EMG-PR) controls—and 2) to compare ratings by control and amputation level. A total of 36 subjects with transradial (TR) or transhumeral (TH) amputation participated in the study. The subjects included 11 EMG-PR users (82% TR) and 25 IMU users (68% TR). The study consisted of in-laboratory training (Part A) and home use (Part B). The subjects were administered the Trinity Amputation and Prosthesis Experience satisfaction scale and other usability and satisfaction measures. Wilcoxon rank-sum tests compared the differences by control type. The differences were compared for those who did and did not want a DEKA Arm. The preferences for features of the DEKA Arm were compared by control type. The comparisons revealed poorer ratings of skill, comfort, and weight among EMG-PR users. The TR amputees using IMUs rated usability more favorably. TH amputees rated usability similarly. The TR amputees using EMG-PR were less satisfied with weight, pinch grip, and wrist display, whereas the TH amputees were less satisfied with the full system, wires/cables, and battery. Usability and satisfaction declined after Part B for EMG-PR users. Overall, we found that the IMU users rated the DEKA Arm and the controls more favorably than the EMG-PR users. The findings indicate that the EMG-PR system we tested was less well accepted than the IMUs for control of the DEKA Arm.