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.

https://journals.sagepub.com/doi/pdf/10.1080/03093640600994581

Upper limb prosthesis use and abandonment: A survey of the last 25 years:

Concurrent related validity of the GAITRite® walkway system for quantification of the spatial and temporal parameters of gait

Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people.

Purpose. To measure consumer satisfaction with upper limb prosthetics and provide an enumerated list of design priorities for future developments.Methods. A self-administered, anonymous survey collected information on participant demographics, history of and goals for prosthesis use, satisfaction, and design priorities. The questionnaire was available online and in paper format and was distributed through healthcare providers, community support groups, and one prosthesis manufacturer; 242 participants of all ages and levels of upper limb absence completed the survey.Results. Rates of rejection for myoelectric hands, passive hands, and body-powered hooks were 39%, 53%, and 50%, respectively. Prosthesis wearers were generally satisfied with their devices while prosthesis rejecters were dissatisfied. Reduced prosthesis weight emerged as the highest priority design concern of consumers. Lower cost ranked within the top five design priorities for adult wearers of all device types. Life-like appearance is a pri...

Consumer design priorities for upper limb prosthetics

http://cyberlearn.hes-so.ch/pluginfile.php/228003/mod_folder/content/0/Kibler_2002.pdf?forcedownload=1

Qualitative clinical evaluation of scapular dysfunction: a reliability study.

Gait analysis, like all clinical assessments, is subject to measurement error. Specification of the extent of measurement error is imperative before drawing conclusions from any test. The purpose of this study was to determine the within-rater and between-rater reliability of observational gait analysis in a pediatric sample wearing knee-ankle-foot orthoses. Three expert observers, using a 3-point scale, rated videotaped gait kinematics of 15 children who had lower limb disability and who wore braces. The rating sessions were then repeated, with one month between sessions. Total agreement (identical ratings), both between-raters and within-raters, occurred in two-thirds of the observations, and an additional 29% of the observations differed by one point. Between-rater intraclass correlation coefficient type 2,1 was .73; within-rater Pearson product-moment correlation averaged .60. Observational kinematic gait analysis appears to be a convenient, but only moderately reliable, technique.

Reliability of Observational Kinematic Gait Analysis

An air impermeable sealing band of rubberized material is introduced between the patient's stump and the interior of a stump-receiving socket of an artificial limb, in one of two ways, depending on whether or not the patient wears a stump sock. If the patient wears a stump sock, the band of sealant material is impregnated into the stump sock. If the patient does not wear a stump sock, an impregnated sock is incorporated into the interior structure of the socket of the patient's prosthesis. The impregnated sock itself is fabricated by placing a conventional stump sock on a somewhat oversized form. An appropriate annular region on the sock is then masked off by means of tightly fitting plastic bags, and one of the plastic bags provides an enclosing outer sheath which encompasses the annular region and extends upwardly above the form. A rubberized material in liquid form is introduced through the top of the outer sheath and a vacuum is introduced below to draw the material into the annular region of the sock, so as top impregnate the same. The rubberized material penetrates the sock, is worked into an axially contoured shaped, and is then permitted to set. A stump-receiving socket for an artificial limb with an integral annular seal is fabricated by placing a stump sock with the seal on a cast of a patient's leg and then laminating the socket over the sock using conventional procedures for manufacturing stump-receiving sockets.

Structure for enhanced retention of artificial limbs and method of fabrication

One hundred twenty below-elbow child amputees compared cosmetically identical myoelectric (MYO) and body-powered (BP) hands after wearing each for 3 months; 78% chose the MYO and 22% chose the BP. However, at 2-year follow-up, only 44% wore the MYO, 33% used a BP hand or hook, and 23% became nonwearers (NW). Eighty percent of children aged > or = 8 years used active prosthetic prehension for both the MYO and BP prostheses. Comparatively, only 30% aged < 8 years and 0% aged < 5 years demonstrated any active prosthetic prehension. Active BP wearers were clearly most pleased with the features of their prostheses.

Myoelectric and body-powered prostheses.

The characteristics and number of children with limb amputations in North America are not known. In an effort to secure information concerning the nature of the child amputee population (to 21 years of age) in the United States and Canada, a census of patients treated at member clinics of the Association of Children's Prosthetic-Orthotic Clinics (ACPOC) was conducted. It was designed to obtain a rational basis for children's prosthetic design, development, research, and educational activities. Of the 74 ACPOC prosthetic clinics to which the questionnaire was sent, 45 replies were analyzed, representing a total of 4,105 children under treatment at the reporting clinics during 1980, of which 679 cases (17%) were seen for the first time in that year. The results are consistent with prior unpublished censuses. Overall, congenital limb deficiencies outnumbered acquired losses by a ratio of 2:1, but among unilateral cases, more lower-limb amputations were acquired postpartum than congenitally. Eighty percent of all child amputees had had only one limb involved, and 54% of these unilateral cases were left amputees. Males outnumbered females 3:2, and over half of the children currently under treatment at the reporting clinics had been under 6 years of age at the time of first admission.

Characteristics of the child amputee population.

The Icelandic-Swedish-New York (ISNY) above-knee prosthetic socket affords juvenile amputees improved comfort, function, and appearance. The flexible polyethylene socket and rigid frame facilitate accommodation to longitudinal and circumferential limb growth. Review of 10 subjects revealed that all who had worn pelvic band suspension with prior prosthesis having rigid sockets could use total or partial suction to suspend prostheses having ISNY sockets.

Sidney Fishman

Papers

Reliability of Observational Kinematic Gait Analysis

Structure for enhanced retention of artificial limbs and method of fabrication

Myoelectric and body-powered prostheses.

Characteristics of the child amputee population.

Icelandic-Swedish-New York above-knee prosthetic sockets: pediatric experience.