Upper limb prosthesis use and abandonment

Abstract

This review presents an analytical and comparative survey of upper limb prosthesis acceptance and abandonment as documented over the past 25 years, detailing areas of consumer dissatisfaction and ongoing technological advancements. English-language articles were identified in a search of Ovid, PubMed, and ISI Web of Science (1980 until February 2006) for key words upper limb and prosthesis. Articles focused on upper limb prostheses and addressing: (i) Factors associated with abandonment; (ii) Rejection rates; (iii) Functional analyses and patterns of wear; and (iv) Consumer satisfaction, were extracted with the exclusion of those detailing tools for outcome measurement, case studies, and medical procedures. Approximately 200 articles were included in the review process with 40 providing rates of prosthesis rejection. Quantitative measures of population characteristics, study methodology, and prostheses in use were extracted from each article. Mean rejection rates of 45% and 35% were observed in the literature for body-powered and electric prostheses respectively in pediatric populations. Significantly lower rates of rejection for both body-powered (26%) and electric (23%) devices were observed in adult populations while the average incidence of non-wear was similar for pediatric (16%) and adult (20%) populations. Documented rates of rejection exhibit a wide range of variance, possibly due to the heterogeneous samples involved and methodological differences between studies. Future research should comprise of controlled, multifactor studies adopting standardized outcome measures in order to promote comprehensive understanding of the factors affecting prosthesis use and abandonment. An enhanced understanding of these factors is needed to optimize prescription practices, guide design efforts, and satiate demand for evidence-based measures of intervention.

Comparison of body-powered voluntary opening and voluntary closing prehensor for activities of daily life

“…Indeed, body-powered prostheses are the primary device used by 78 percent of Vietnam veterans and 38 percent of Operation Iraqi Freedom/Operation Enduring Freedom veterans with an upper-limb amputation [7]. However, body-powered prostheses are still abandoned at high rates, with estimates ranging between 26 [8] and 50 percent [9]. One of the main causes of abandonment is the limited function of the prehensor [9], especially when compared with an intact contralateral hand.…”

Neural growth into a microchannel network: Towards A regenerative neural interface

“…However, both neural interfacing approaches have limited control over neuroprosthesis and also provide a small degree or no neural feedback to the user [2]; this is cited as a requisite toward improved acceptance and usability of prosthetic limbs in the daily lives of patients [4]. The work presented here is an initial investigation into a peripheral nervous system (PNS) interfacing approach proposed to address issues of alternate interfacing strategies while providing improved control and feedback for a neuroprosthetic device.…”

“…If a nerve bundle is severed, neurites regrow from the proximal nerve stump in an attempt to find appropriate innervation targets [4]. Sieve electrodes take advantage of this mechanism, with a disc-like structure placed in a nerve transection between the proximal and distal ends of the stump.…”

Development and testing of new upper-limb prosthetic devices: Research designs for usability testing

“…In their 2007 review of more than 200 articles on prosthesis use and abandonment, Biddiss and Chau noted that technological factors relating to discomfort and limited function, particularly for those with higher levels of limb loss, were among the major reasons for prosthetic dissatisfaction and abandonment [2]. Additional reasons for dissatisfaction and abandonment included problems related to durability and mechanical failure, discomfort, control, and cosmesis [2][3][4][5][6]. Although design priorities identified by consumers varied by type of device and level of amputation, identified priorities generally included such key areas as reduced weight, lower cost, improved comfort, increased movement, and greater dexterity [2].…”