Health services utilization in adult acquired major upper-limb amputees: A population-based survey

Introduction Military Service Members (SMs) with upper limb (UL) amputation have unrestricted access to occupational therapy (OT) services. Identifying OT interventions used based on clinical rationale and patient needs can provide insight toward developing best practice guidelines. The purpose of this retrospective observational study was to identify preferred OT practice patterns for U.S. Military SMs treated in Military Treatment Facilities, who have sustained various levels of deployment-related UL amputation. Methods The study sample was ascertained from the Expeditionary Medical Encounter Database housed at the Naval Health Research Center in San Diego, California. SMs with an immediate (within 24 hours of injury) deployment-related unilateral major UL amputation (partial hand and proximal), occurring between January 2001 and December 2014 were identified. SMs with concurrent major lower limb amputation (partial foot and proximal) were excluded. Frequency of OT outpatient visits and units of treatment received were quantified in 3-month increments during the first year after amputation and compared for individuals with above elbow (at or proximal to elbow joint) and below elbow (distal to the elbow joint including partial hand) amputation. This study was approved by the Naval Health Research Center Institutional Review Board. Results A total of 29,878 encounters occurred during first year after amputation in 148 patients, who had sustained UL loss during the first year after amputation. Active treatments were included in 79.2% of all treatments, followed by manual therapy (13.7%) and modalities (13.5%). A higher number of OT encounters occurred in the above elbow amputation group—the first year of treatment with significantly higher mean number of treatments months 4 to12. A similar pattern in OT encounters was observed in the active therapy category with significantly higher mean number of treatments occurring in above elbow limb loss group in months 10 to 12. Conclusion Findings of the current study suggest SMs with UL amputation utilize OT services often within the first year after injury and those who have sustained amputation proximal to the elbow received more therapy visits than their below elbow counterparts during months 4 to 12. Prosthetic training, therapeutic activities, and therapeutic exercise can be expected to be the highest used active interventions in the first year following UL amputation. Further research is needed to determine details on types and frequency of therapy utilization and recommended therapy strategies.

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Decoding the grasping intention from electromyography during reaching motions

Batzianoulis

Krausz

Simon

et al. 2018

J NeuroEngineering Rehabil

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BackgroundActive upper-limb prostheses are used to restore important hand functionalities, such as grasping. In conventional approaches, a pattern recognition system is trained over a number of static grasping gestures. However, training a classifier in a static position results in lower classification accuracy when performing dynamic motions, such as reach-to-grasp. We propose an electromyography-based learning approach that decodes the grasping intention during the reaching motion, leading to a faster and more natural response of the prosthesis.Methods and ResultsEight able-bodied subjects and four individuals with transradial amputation gave informed consent and participated in our study. All the subjects performed reach-to-grasp motions for five grasp types, while the elecromyographic (EMG) activity and the extension of the arm were recorded. We separated the reach-to-grasp motion into three phases, with respect to the extension of the arm. A multivariate analysis of variance (MANOVA) on the muscular activity revealed significant differences among the motion phases. Additionally, we examined the classification performance on these phases. We compared the performance of three different pattern recognition methods; Linear Discriminant Analysis (LDA), Support Vector Machines (SVM) with linear and non-linear kernels, and an Echo State Network (ESN) approach. Our off-line analysis shows that it is possible to have high classification performance above 80% before the end of the motion when with three-grasp types. An on-line evaluation with an upper-limb prosthesis shows that the inclusion of the reaching motion in the training of the classifier importantly improves classification accuracy and enables the detection of grasp intention early in the reaching motion.ConclusionsThis method offers a more natural and intuitive control of prosthetic devices, as it will enable controlling grasp closure in synergy with the reaching motion. This work contributes to the decrease of delays between the user’s intention and the device response and improves the coordination of the device with the motion of the arm.Electronic supplementary materialThe online version of this article (10.1186/s12984-018-0396-5) contains supplementary material, which is available to authorized users.

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Health services utilization in adult acquired major upper-limb amputees: A population-based survey

Cited by 5 publications

References 28 publications

Delayed referral of lower limb amputees for rehabilitation; an audit study

Delayed referral of lower limb amputees for rehabilitation; an audit study

Occupational Therapy Practice Patterns for Military Service Members With Upper Limb Amputation

Decoding the grasping intention from electromyography during reaching motions

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