The roles of predisposing characteristics, established need, and enabling resources on upper extremity prosthesis use and abandonment.

Bloorview Research Institute, Toronto, ONT, Canada.
Disability and Rehabilitation Assistive Technology 04/2007; 2(2):71-84. DOI: 10.1080/17483100601138959
Source: PubMed

ABSTRACT Prosthesis use and abandonment is a complex function of variables defining the contextualized individual. This review presents a comprehensive panoramic of these factors as related to the management of upper limb deficiency. Me
nderson's model for health service utilization was used to frame prosthesis use and abandonment as a function of (1) predisposing characteristics of the individual (e.g. gender or level of limb loss); (2) established need, as characterized by lifestyle- and age-related demands; and (3) enabling resources (e.g. clinical and social). English-language articles pertaining to these components were identified in a search of Ovid, PubMed, ISI Web of Science and (1980-November 2006) for key words upper limb and prosthesis. Approximately 90 articles were included as evidence in this review. Re
ersonal and contextual factors are critical determinants of prosthesis acceptance. While the influence of some factors (i.e. lifestyle, level of limb loss), is strongly supported in the literature, the impact of others, (i.e. age of fitting, efficacy of training protocols), remain controversial. Co
nhanced understanding of these factors is required to optimize clinical practices, guide design efforts, and satiate demand for evidence-based measures of intervention. Future research should comprise of controlled, multifactor studies adopting standardized outcome measures and providing comprehensive descriptions of population characteristics.

  • [Show abstract] [Hide abstract]
    ABSTRACT: For several decades, prosthetic use was the only option to restore function after upper extremity amputation. Recent years have seen advances in the field of prosthetics. Such advances include prosthetic design and function, activity-specific devices, improved aesthetics, and adjunctive surgical procedures to improve both form and function. Targeted reinnervation is one exciting advance that allows for more facile and more intuitive function with prosthetics following proximal amputation. Another remarkable advance that holds great promise in nearly all fields of medicine is the transplantation of composite tissue, such as hand and face transplantation. Hand transplantation holds promise as the ultimate restorative procedure that can provide form, function, and sensation. However, this procedure still comes with a substantial cost in terms of the rehabilitation and toxic immunosuppression and should be limited to carefully selected patients that have failed prosthetic reconstruction. Hand transplantation and prosthetic reconstruction should not be viewed as competing options. Rather, they are two treatment options with different risk/benefit profiles and different indications and, hence vastly different implications.
    Journal of Hand Therapy 01/2013; · 1.17 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Training increases the functional use of an upper limb prosthesis, but little is known about how people learn to use their prosthesis. The aim of this study was to describe the changes in performance with an upper limb myoelectric prosthesis during practice. The results provide a basis to develop an evidence-based training program. Thirty-one able-bodied participants took part in an experiment as well as thirty-one age- and gender-matched controls. Participants in the experimental condition, randomly assigned to one of four groups, practiced with a myoelectric simulator for five sessions in a two-weeks period. Group 1 practiced direct grasping, Group 2 practiced indirect grasping, Group 3 practiced fixating, and Group 4 practiced a combination of all three tasks. The Southampton Hand Assessment Procedure (SHAP) was assessed in a pretest, posttest, and two retention tests. Participants in the control condition performed SHAP two times, two weeks apart with no practice in between. Compressible objects were used in the grasping tasks. Changes in end-point kinematics, joint angles, and grip force control, the latter measured by magnitude of object compression, were examined. The experimental groups improved more on SHAP than the control group. Interestingly, the fixation group improved comparable to the other training groups on the SHAP. Improvement in global position of the prosthesis leveled off after three practice sessions, whereas learning to control grip force required more time. The indirect grasping group had the smallest object compression in the beginning and this did not change over time, whereas the direct grasping and the combination group had a decrease in compression over time. Moreover, the indirect grasping group had the smallest grasping time that did not vary over object rigidity, while for the other two groups the grasping time decreased with an increase in object rigidity. A training program should spend more time on learning fine control aspects of the prosthetic hand during rehabilitation. Moreover, training should start with the indirect grasping task that has the best performance, which is probably due to the higher amount of useful information available from the sound hand.
    Journal of NeuroEngineering and Rehabilitation 02/2014; 11(1):16. · 2.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Purpose: To quantify prescription and repair rates of prosthetic limbs in the Department of Veterans Affairs (VA) and explore differences by level, type, and age. Methods: Veterans (N = 32 440) with an initial prosthetic prescription between 2000 and 2010 were classified by amputation level and type. Annual rates of prescription and repair were calculated using person-time and compared by group. Results: Veterans with upper limb amputation had lower annual prescription and repair rates (0.28 and 0.21) compared with those with lower limb amputation (0.40 and 0.56). Myoelectric devices users had higher prescription rates. However, body-powered users had higher repair rates. Prescription and repair rates for microprocessor knee joints were higher than for fluid and friction devices. Veterans under 65 had 0.07 and 0.16 higher rates of prescription and repair than those over 65 (p < 0.0001). Conclusions: Because the VA is unconstrained by co-pays or caps, data on prosthetic prescription and repair can be used to estimate rates that might occur if national prosthetic parity laws were adopted. Given the rates found, it is likely that annual costs would exceed the typical annual and/or lifetime caps in most insurance plans. In states without prosthetic parity laws, such costs likely limit access to needed devices. Implications for Rehabilitation For the almost 2 million people in the United States living with an amputation or congenital limb loss, purchasing and maintaining a prosthetic limb can be costly, with insurances often imposing annual or lifetime caps. Data on prosthetic purchasing and repair is limited and reliant on self-reported information. Because the VA is unconstrained by co-pays or caps, claims data on prosthetic prescription and repair can be used to estimate rates that might occur if national prosthetic parity laws were adopted. Given the rates found, it is likely that annual costs would exceed the typical annual and/or lifetime caps in most insurance plans. In states without prosthetic parity laws, such costs likely limit access to needed devices.
    Disability and rehabilitation. Assistive technology. 05/2014;