ABSTRACT. Light CM, Chappell PH, Kyberd PJ. Establishing a standardized clinical assessment tool of pathologic and prosthetic hand function: normative data, reliability, and validity. Arch Phys Med Rehabil 2002;83:776-83.Objective: To develop a new assessment procedure, the Southampton Hand Assessment Procedure (SHAP), that allows contextual results of hand function to be obtained readily in a clinical environment.Design: Reliability (test-retest, interrater) and validity (criterion, content) of new assessment procedure against standard medical outcome measure techniques.Setting: Normative data collected in a university laboratory. Participants: Twenty-four volunteers selected on the basis of optimum hand function using these criteria: age (range, 18-25y), and no adverse hand trauma, neurologic condition, or disabling effects of the upper limb.Interventions: Not applicable. Main Outcome Measures:The normative control group was assessed for variability, and the procedure measured in terms of interrater and test-retest reliability. The absence of a direct comparison prevents a criterion standard from being established; however, content validity was shown by expert peer review.Results: The control group data were shown to be multivariate gaussian; test-retest and interrater reliability were demonstrated at the 95% confidence level. The content validity was demonstrated by peer panel approval.Conclusions: Results of the control group established the statistical integrity of SHAP. Clinical trials are underway, although more extensive use of the procedure is advocated in primary care and rehabilitation centers where physiotherapy and occupational therapy are actively used in hand rehabilitation.

Abstract-The recent introduction of novel multifunction hands as well as new control paradigms increase the demand for advanced prosthetic control systems. In this context, an unambiguous terminology and a good understanding of the nature of the control problem is important for efficient research and communication concerning the subject.Thus, one purpose of this paper is to suggest an unambiguous taxonomy, applicable to control systems for upper limb prostheses and also to prostheses in general. A functionally partitioned model of the prosthesis control problem is also presented along with the taxonomy.In the second half of the paper, the suggested taxonomy has been exploited in a comprehensive literature review on proportional myoelectric control of upper limb prostheses.The review revealed that the methods for system training have not matured at the same pace as the novel multifunction prostheses and more advanced intent interpretation methods. Few publications exist regarding the choice of training method and the composition of the training data set. In this context, the notion of outcome measures is essential. By definition, system training involves optimization, and the quality of the results depends heavily on the choice of appropriate optimization criteria. In order to further promote the development of proportional myoelectric control, these topics need to be addressed.

Failure ofconservative treatment is the usual indication for the reconstruction of a knee with deficiency of the anterior cruciate ligament (ACL) and this depends on subjective judgement. The ability of muscles to protect the subluxing joint by reflex contraction could provide an objective measurement. We have studied 30 patients with unilateral ACL deficiency by measuring the latency of reflex hamstring contraction. We found that the mean latency in the injured leg was nearly twice that in the unaffected limb (99 ms and 53 ms respectively). There was a significant correlation between the differential latency and the frequency of 'giving way' indicating that functional instabifity may be due, in part, to loss of proprioception. Measures of proprioception, including reflex hamstring latency, may be useful in providing an objective assessment of the efficacy of conservative treatment and the need for surgery.

Abstract-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.