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


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.

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    • "Training programs used nowadays to learn to use an upper limb prosthesis are still clinic specific, [1] rather than evidence-based practice [2,3]. Therefore, it is not known whether a certain training protocol is the most efficient training to facilitate acquisition of prosthetic skills [1]. Hence, there is a growing support for the need of an evidence-based training program [4-7]. "
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    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. DOI:10.1186/1743-0003-11-16 · 2.74 Impact Factor
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    ABSTRACT: In this chapter, we address questions of prosthesis acceptance, design, and supporting resources from the perspective of consumer needs. Throughout, the observations presented are largely based on the experiences of approximately 250 individuals with upper limb absence, and are supported by the literature of the past 25 years. The choice to accept or reject a prosthesis is largely dictated by personal needs and is made in such a way so as to optimize quality of life. Prosthesis design should first focus on maximizing comfort, particularly by reducing the weight and improving the thermal properties of current models. Consumers are also interested in reduced costs, enhanced sensory feedback, and life-like dexterity and appearance. Ongoing initiatives and technological development to address these consumer design priorities are discussed. Lastly, perspectives on enabling healthcare and economic resources fundamental to the prescription and availability of prostheses are outlined. Clinical strategies to promote prosthesis acceptance are identified and consumer-directed recommendations for social support structures are detailed.
    Amputation, Prosthesis Use, and Phantom Limb Pain, 01/1970: pages 7-21;

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