The principal point of upper limb prosthetics is to restore the missing portion aesthetically (Demir, 2023). Given that the purpose is purely aesthetic, efforts are made to replicate the movements and actions of the human hand closely. These devices can enhance functionality by aiding the intact hand/arm in performing tasks requiring both hands (Gruber et al. 2021). For instance, a passive prosthesis can secure papers while writing, assist in carrying objects, stabilize items the unaffected hand holds, and enhance social engagement.
Kinematic studies have long been used in clinical research, particularly for analyzing the gait patterns of individuals with lower-limb amputation (National Academies of Sciences, Engineering, and Medicine et., al 2017). However, these investigations are somewhat limited in upper-limb prosthetics due to their complexity (not automated and asymmetrical) compared to lower-limb actions. Touillet et al., (2022) state that an enhanced understanding of compensatory methods is essential for comprehending the adaptive mechanisms of the motor system in amputees and its subsequentprosthesis-based partial replacement.
This paper aims to comprehensively analyze the current literature about the movement patterns of upper limb prosthetic devices during daily activities, focusing on the weaknesses and strengths of existing research practices, the most important results, and specific fields that need to be explored simultaneously.
Critique of the Literature
This part gives a detailed assessment of the two papers: The first research paper is titled “Kinematic analysis of Motor Learning in upper limb body-powered bypass prosthesis training”, elaborated by (Bloomer et al., 2020), and the second paper “Kinematic Analysis of impairments and compensatory motor behaviour during prosthetic grasping in below-elbow amputees” conducted by (Trouliette et al., 2022)
Population and Sampling
The subject of paper 1 was three male and 3females right-handed participants with normal upper limb anatomy and functionality. The average age of the participants was 27, with a standard deviation of 3. Paper 2 was focused on a sample of 10 people who had amputations below the knee. The participants comprised one female and nine male, aged between 22 and 61. The limited number of participants makes their findings impossible to generalize in both papers.
Data Collection
The focus of Bloomer et al. (2020) was on the persons with upper limb amputation of body-powered bypass prostheses, and they used structured tools: Box and Blocks Test (BBT) and the Jebsen-Taylor hand function tests (JTHFT). In most countries of the world, JTHFT is a non-diagnostic measure that assesses the degree of ability of the hand and forearm, which could be involved in diseases like stroke, progressive muscular dystrophy, spinal cord injury, carpal tunnel syndrome, Parkinson’s disease, and rheumatoid arthritis to perform routine tasks (Berardi et al., 2022). The JTHFT is the right tool for ensuring that one person can objectively evaluate the activities involving the hand and upper limb after an amputation. By the same indication, Kontson et al. (2017) concluded that the BBT is a pervasive functional outcome test mostly used in a diverse range of clinical settings because the test provides the advantage of repeating action, being reliable, objectively measuring and being done speedily and efficiently.
Touillet et al. (2022) used Polhemus Fastrak for data tracking, capacitive 6DOF electromagnetic, and a sampling frequency of 30 Hz. The Polhemus transmitter provides the position data and Euler angles of azimuth, elevation, and roll in the local coordinate system. X-axis implies moving right, y–axis means going forward, and z–axis means going upwards. As the SPACE FASTRAK User’s Manual Revision F says, Polhemus Inc., 1993, this coordination claimed that its retrieved root mean square (RMS) values were 0.5-1 mm in position and 0.6° in orientation when implemented within a 76-cm distance from the probe to the sensor.
Methodology
Bloomer et al., (2020) performed a study to assess how prosthesis education affects adaptive motion and the development of motor skills in amputated individuals. They conducted several functional, kinematic, and kinetic investigations, later comparing the outcomes in two time points, employing a within-subject paradigm. On the other hand, Touillet et al. (2022) carried out an observational case study to record the grasping kinematics in ten people who had myoelectric prosthetics and had suffered below-elbow amputation. The nature of the observational research made it possible to understand better the compensatory strategies these patients used.
Outcomes
Paper 1 presents quantifiable and replicable results, including measurements of joint-specific route length and normalized jerk. These findings are valuable in the context of motor learning and the control of prosthetics for individuals. However, Paper 2 focuses on the challenges of understanding how amputees can control prosthetics by studying the compensatory movements they make.
Data Validity and Effectiveness of Results
Both papers show methodical rigour (there are no identical steps throughout the process), and they do have some differences. In Paper 1, quantified and reproducible findings such as the joint-specific route length and the normalized jerk are presented, which prove helpful due to their role in motor learning and control of prosthetics for people. It was shown through the analysis of data collection at the joint level that the training enhanced user individuals’ engagement during task execution (Bloomer et al., 2020). Provided that the exercise implies the variation in joint motion, each activity contributes to restoring normal movement (the increased variability). According to the parameters, the efficiency of the course was improved, as attested by the shortening of joint travel spending. Yet, the gains relative to effectiveness were smaller than those achieved on the completeness of quickness or smoothness (Bloomer et al., 2020). The scores for repeated tasks and moving together were reported to be higher, meaning it is more difficult to develop high performance.; efficiency in motor learning may be a more multidimensional and situation-dependent characteristic. Despite all the progress in this topic, there are still boundaries that may appear due to the limited amount of healthy participant groups and the applicability of data to the clinical population.
On the other hand, Paper 2 highlights the difficulties of grasping a prosthetic by providing a thorough kinematic analysis of compensatory mechanisms used by amputees. Significant temporospatial deficits in prosthetic gripping were evident, which aligns with earlier kinematic or clinical findings. The components of reaching and gripping separated, and the grasping phase was lengthened. Average symmetry existed in the 3D hand displacement, while significant object-specific variations existed. Hand position while clutching revealed distinct side disparities, with a more “thumbs up” roll and a more frontal azimuth. The prosthetic hand’s altered orientation concerning the item indicated that hand attitude had to be adjusted due to the restricted movement of the fingers and wrists. A limited convenience sample of participants in the early observational study prevents the population from being stratified into homogeneous subgroups.
Alignment of Findings
The results in paper 1 provide a quantitative description of many elements of motor learning and control in non-disabled participants, which could help shape future training and rehabilitation programs for body-powered prosthesis users. Conversely, the findings presented in paper 2 provide more understanding of the mechanisms underlying the compensatory measures, which may result from heightened proximal or distal kinematic limitations. Creating novel prosthetics and preventing musculoskeletal problems depend on a deeper understanding of these compensatory mechanisms. The results from paper one and paper 2 complement each other, and the differences are attributed to the variations in the study populations, approaches, and outcome measures.
Strengths and Weaknesses
Paper 1’s strengths lie in its quantitative analysis, which provides a comprehensive and quantifiable understanding of the research topic. The efficacy of training interventions in physically capable persons can be comprehended through the quantitative examination of motor learning processes. For example, training has been shown to affect device acceptability and function when prescribing prostheses. BP prostheses are widely utilized for motor learning. By knowing how training affects performance, therapists may better customize rehabilitation. Ultimately, the smaller sample size of this study limits its findings, even though it shows significant changes in motor control among users of innovative prosthetics.
Conversely, paper 2’s strengths include its detailed kinematic analysis of compensatory strategies. To prevent musculoskeletal problems and create cutting-edge prosthetics, a thorough kinematic study provides greater insight into the mechanics underlying compensatory techniques that may be brought on by increasing proximal or distal kinematic limitations.
Nevertheless, limitations include the study’s observational nature: they can be used only to find associations between risk factors and responses, but they cannot establish causation alone.
Statistical Appraisal
While both studies demonstrated methodological rigour, they did not explicitly state the specific statistical analyses employed. Paper 1 exhibited rigour by presenting data that were quantifiable and reproducible. However, Paper 2 provided valuable insights by thoroughly investigating motion, but it did not include specific statistical validation.
Brief Protocol
Research Design
The research will employ a mixed-methods approach to understand upper limb prosthetic function comprehensively. According to Schoonenboom and Johnson (2017), mixed methods research aims to enhance and support a study’s findings and add to the existing literature.
Methodology
Kinematic analysis with motion capture technologies will gather quantitative data, following the same methods as earlier research projects (Bloomer et al., 2020). The body-powered bypass prosthesis, which includes a figure-of-eight harness, manual wrist rotation, and a voluntary opening Hosmer 5X hook terminal device, will be supplied by Arm Dynamics (Dallas, TX). Qualitative data will be acquired through questionnaires or interviews to assess the aesthetic, psychological and functional aspects of the body incorporation of the prosthetic device.
Equipment and Tools
Quantitative analysis will require Vicon or Optitrack motion capture devices to record three-dimensional motion data accurately. In addition, motion tracking can be performed in the real world using wearable sensors such as inertial measurement units (IMUs). Questionnaires or interview guides will be used to collect qualitative information from the participants.
Tasks Assessed
The study will evaluate various tasks, such as handling objects of different sizes and weights, performing reaching and grasping tasks at different distances and angles, executing delicate motor tasks that require precision and dexterity, simulating daily activities like pouring, cutting, or typing, and performing functional tasks related to work, leisure, or personal care.
Procedures
Participants with a below-elbow amputation will be recruited from prosthetic rehabilitation centres across the UK. The inclusion criteria include having a myoelectric prosthesis, having normal or corrected vision, and having an amputation or birth defect at the forearm level. The existence of another upper limb that affects neurological or orthopaedic pathology serves as the exclusion criterion. The regional ethical board will review and approve the protocol, and prior to participation, each subject will provide written informed consent.
Variables and Outcome Measures
The study will assess the range of motion, joint angles, patterns of coordination, effectiveness, compensating techniques in prosthesis use, and indicators of quality of life, such as task completion times and smoothness of movement (such as normalized jerks). These measurements will guide future interventions and advancements in upper limb prostheses by understanding the strengths and weaknesses of various prosthetic designs and rehabilitation techniques.
References
Berardi, A., Galeoto, G., Pasquali, F., Baione, V., Crisafulli, S. G., Tofani, M., Tartaglia, M., Fabbrini, G., & Conte, A. (2022). Evaluation of the Psychometric Properties of Jebsen Taylor Hand Function Test (JTHFT) in Italian Individuals With Multiple Sclerosis. Frontiers in neurology, 13, 847807. https://doi.org/10.3389/fneur.2022.847807
Bloomer, C., Wang, S., & Kontson, K. (2020). Kinematic analysis of motor learning in upper limb body-powered bypass prosthesis training. PloS one, 15(1), e0226563. https://doi.org/10.1371/journal.pone.0226563
Demir Y. (2023). Upper limb prosthetic prescription. Turkish journal of physical medicine and rehabilitation, 69(3), 261–265. https://doi.org/10.5606/tftrd.2023.12933
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on the Use of Selected Assistive Products and Technologies in Eliminating or Reducing the Effects of Impairments; Flaubert, J. L., Spicer, C. M., & Jette, A. M. (Eds.). (2017). The promise of assistive technology to enhance activity and work participation (Upper-Extremity Prostheses). Washington, DC: National Academies Press (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK453290/
Kontson, K., Marcus, I., Myklebust, B., & Civillico, E. (2017). Targeted box and blocks test Normative data and comparison to standard tests. PloS one, 12(5), e0177965.
Touillet, A., Gouzien, A., Badin, M., Herbe, P., Martinet, N., Jarrassé, N., & Roby-Brami, A. (2022). Kinematic analysis of impairments and compensatory motor behaviour during prosthetic grasping in below-elbow amputees. PloS one, 17(11), e0277917. https://doi.org/10.1371/journal.pone.0277917
Major, M. J., Stine, R. L., Heckathorne, C. W., Fatone, S., & Gard, S. A. (2014). Comparison of range-of-motion and variability in upper body movements between trans-radial prosthesis users and able-bodied controls when executing goal-oriented tasks. Journal of Neuroengineering and Rehabilitation, 11, 132. PMID: 25192744.
Schoonenboom, J., & Johnson, R. B. (2017). How to construct a mixed methods research design. Kolner Zeitschrift fur Soziologie und Sozialpsychologie, 69(Suppl 2), 107.
Gruber, L., & Lau, T. M. (2021, April 29). Upper limb prosthetics. https://now.aapmr.org/upper-limb-prosthetics/
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