People with major limb amputations are severely impaired when it comes to activity, body structure and function, as well as participation. Demographic statistics predict a dramatic increase of this population and additional challenges with their increasing age and higher levels of amputation. Prosthetic use has been shown to have a positive impact on mobility and depression, thereby affecting the quality of life. Biomechatronic prostheses are at the forefront of prosthetic development. Actively powered designs are now regularly used for upper limb prosthetic fittings, whereas for lower limbs the clinical use of actively powered prostheses has been limited to a very low number of applications. Actively powered prostheses enhance restoration of the lost physical functions of an amputee but are yet to allow intuitive user control. This paper provides a review of the status of biomechatronic developments in upper and lower limb prostheses in the context of the various challenges of amputation and the clinically relevant outcomes. Whereas most of the evidence regarding lower limb prostheses addresses biomechanical issues, the evidence for upper limb prostheses relates to activities of daily living (ADL) and instrumental ADL through diverse outcome measures and tools.
While over 1.5 million individuals are living with limb loss in the United States (Ziegler-Graham et al., 2008), only 10% of these individuals have a loss that affects an upper limb. Coincident with the relatively low incidence of upper limb loss, is a shortage of the community-based prosthetic rehabilitation experts that can help prosthetic users to more fully integrate their devices into their daily routines. This article describes how expert prosthetists and occupational therapists at Touch Bionics, a manufacturer of advanced upper limb prosthetic devices, employ Voice over the Internet Protocol (VoIP) videoconferencing software telehealth technologies to engage in remote consultation with users of prosthetic devices and/or their local practitioners. The Touch Bionics staff provide follow-up expertise to local prosthetists, occupational therapists, and other health professionals. Contrasted with prior telephone-based consultations, the video-enabled approach provides enhanced capabilities to benefit persons with upper limb loss. Currently, the opportunities for Touch Bionics occupational therapists to fully engage in patient-based services delivered through telehealth technologies are significantly reduced by their need to obtain and maintain professional licenses in multiple states.
Introduction Despite the large number of individuals experiencing partial hand limb loss or deficiency, and the impact of this level of loss on hand function, there is minimal research available regarding the benefit of partial hand externally powered prostheses. The purpose of this research was to explore how using an externally powered partial hand prosthesis contributes to the completion of functional tasks. Materials and Methods Fifteen individuals being fit with i-digits partial hand prostheses were evaluated using the Southampton Hand Assessment Procedure (SHAP) and Patient-Specific Functional Scale (PSFS). The individuals were each fit during a 1-week condensed fitting and training process and received 10 to 15 hours of therapy between the prefitting and postfitting testing. Results Twelve male and three female clients with four- (with thumb remaining) or five-digit partial hand limb loss or deficiency participated. Average age was 42 years, and 87% had acquired amputations an average of 2.44 years before the fitting. All subjects demonstrated clinically significant change scores on both the PSFS and the SHAP. The individuals with five-digit absence demonstrated marked improvement in comparison with those with four-digit absence; however, both were far superior to the minimal detectable change score for the SHAP, with 42.33 and 19.16 average improvement scores, respectively. Conclusions Subjects fit with four- or five-digit externally powered partial hand prostheses demonstrated significant functional improvements in objective hand function and individualized goals. The remnant thumbs of users fit with four-digit systems sometimes exhibited limitations on range of motion or strength. Despite this, their evaluation scores still showed significant improvement; in fact, almost 10 times the minimal detectable change score. For those with five-digit absence, the change was 20 times the minimal threshold. These results suggest the benefit of the i-digits partial hand prosthesis as contributing to the function of individuals with partial hand limb loss or deficiency, particularly with the individuals' priority functional goals.
Abstract-Based on recent advances in prosthetic technology available for individuals with partial hand loss or deficiency, research is needed to best ensure the acceptance of these devices. Additionally, this population is subjected to higher risks of overuse syndromes. With improved technological advances in prosthetic devices, clients can engage in more complex activities with less compensation. The purpose of this study was to describe the tasks identified as both difficult and important to individuals with partial hand loss. Recommendations will be provided regarding matching users' individualized goals with considerations in prosthetic design, functional training, programming, and adaptive equipment.
Background: Loss of the hand results in significant functional deficits and requires adaptation of movement patterns which may result in overuse injuries. An externally powered prosthesis may improve function of the affected limb and reduce the overreliance on the intact side; however, little research has been done in this area. Objective: Investigate changes in upper limb function and kinematics in individuals with partial-hand amputations performing a functional assessment by comparing results with and without a multi-articulating hand prosthesis. Study design: Cross-sectional. Methods: Three-dimensional kinematics of four- and five-digit limb loss participants were collected as they performed the Southampton Hand Assessment Procedure with and without a prothesis. Results: Ten males completed the protocol: five with four-digit loss (thumb intact) and five with five-digit loss. Significantly larger joint motions were seen without the prosthesis than with for all participants, which may be an indicator of higher risk for overuse injury. Significant improvement was seen in Southampton Hand Assessment Procedure scores in the five-digit limb loss participants using the prosthesis compared with not using the device ( p < 0.05 for 6/7 Southampton Hand Assessment Procedure score categories). Conclusion: The prosthesis reduced functional deficits and decreased joint range of motion in individuals with partial hand loss. Results showed reduced compensatory motions throughout the upper limb and torso which may reduce the risk of overuse injury. Clinical relevance Results of this study indicate that externally powered partial hand prostheses can be effective in improving function and reducing compensation in individuals with partial hand loss.
Effective fieldwork provides students with learning experiences in preparation for entry-level practice as occupational therapists (OT) or occupational therapy assistants (OTA). In 2003, the National Board for Certification in Occupational Therapy, Inc.® (NBCOT) conducted a practice analysis of entry-level certified occupational therapy practitioners (OTR & COTA) to validate a test blueprint for the national certification examinations. This study reports a novel, elective survey reflecting the total percentage of entry-level practitioners, who reported use of 88 different interventions. The purpose of this paper is to translate the practice analysis intervention data gathered in the optional survey to plan and implement effective fieldwork that prepares fieldwork students for entry-level practice. The results of this study will provide understanding of intervention use among entry-level practitioners (OTR = 479; COTA = 168) as a function of practice context. An initial correlation of a random sample of 100 OTRs and COTAs found group equivalency, meaning that the OTR information could be used for the major analyses and generalized to include COTA. Fourteen interventions were found commonly across all practice settings for OTR. These fourteen were factored into three areas or themes (preparatory and activities of daily living; motor skills, posture and coordination; and mental functions) with significant frequency of intervention utilization. Further analysis indicated a high variability of the top thirty interventions for each setting with regard to utilization of interventions above and below the 50 percentile. This snapshot of practice regarding entry-level intervention utilization in occupational therapy across seven major practice settings is described and application to fieldwork processes elaborated. The information provides a description of practice in each setting that can be used by academic fieldwork coordinators for student placement decisions. Fieldwork educators can use this information as a guide for planning comprehensive fieldwork-learning activities, as well as supervising students. Fieldwork students can use this intervention utilization information to assess their readiness for entry-level practice in each setting.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.