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Abstract
We aim to present a standard protocol for training able-bodied individuals to use a body-powered bypass prosthesis and assess training length and impact of prepositioning. The protocol design and subsequent analysis aims to facilitate controlled and efficient implementation of the able-bodied bypass user in the research setting. Six volunteers completed ten two-hour sessions with a body-powered bypass prosthesis. Each session included standardized training tasks: object manipulation, free training, and activities of daily living. Two outcome measures, a modified Southampton Hand Assessment Procedure and the Box and Blocks Test were used to score performance during each session. A standard learning curve was fitted to the scores to determine an optimal training length based on learning rate and learning plateau values; further tested through an effect size calculation. To assess prepositioning, scores were normalized and grouped by a measure of terminal device rotations. Scores then underwent a linear regression analysis. Optimal training lengths were found to be three and six sessions for modified Southampton Hand Assessment Procedure and Box and Blocks Test results respectively, with support from effect size calculations. Prepositioning and normalized score were weakly correlated, +0.38, and poorly fit, R 2 = 0.016, contradictory to the expected strong correlation that would accompany the supposed performance benefits attributed to prepositioning. A lack of resources to guide the use of upper limb bypass prostheses is addressed with the presented standard, quantitatively assessed protocol. A framework for evaluating adequate training length and prepositioning is established and shared.
Highlights
In upper limb amputee and prosthesis research, the bypass prosthesis has shown promise as a resource in study design [1,2,3,4,5]
A bypass prosthesis, or prosthetic simulator, is a device that allows a non-disabled user to activate a specific type of terminal device with similar controls that an amputee would use to operate a custommade prosthesis
This allows upper limb prosthesis research to be conducted without the challenges of recruiting from a small population of upper limb amputees with varied prosthesis experience
Summary
In upper limb amputee and prosthesis research, the bypass prosthesis has shown promise as a resource in study design [1,2,3,4,5]. A bypass prosthesis, or prosthetic simulator, is a device that allows a non-disabled user to activate a specific type of terminal device with similar controls that an amputee would use to operate a custommade prosthesis. This allows upper limb prosthesis research to be conducted without the challenges of recruiting from a small population of upper limb amputees with varied prosthesis experience. To ensure feasibility of research with bypass users, training needs be both controlled and efficient. This need presents a unique challenge for researchers using these devices as they aim to control and justify distinct aspects of training within their own experimental designs and protocols
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