Southampton Hand Assessment Procedure Research Articles

Clinical, Radiographic, and Biomechanical Evaluation of the Upper Extremity in Patients with Osteogenesis Imperfecta.

Introduction: Osteogenesis imperfecta (OI) is a hereditary disorder primarily caused by mutations in type I collagen genes, resulting in bone fragility, deformities, and functional limitations. Studies on upper extremity deformities and associated functional impairments in OI are limited. This cross-sectional study aimed to evaluate upper extremity deformities and functional outcomes in OI. Methods: We included patients regardless of their OI subtypes with a minimum age of 7 years. Radiographic analysis of radial head dislocation, ossification of the interosseous membrane, and/or radioulnar synostosis of the forearm were performed, and deformity was categorized as mild, moderate, or severe. Clinical evaluation was performed using the Quick Disabilities of Arm, Shoulder, and Hand (qDASH) questionnaire and shoulder-elbow-wrist range of motion (ROM). Three-dimensional motion analysis of the upper limb was conducted using the Southampton Hand Assessment Procedure (SHAP). The SHAP quantifies execution time through the Linear Index of Function (LIF) and assesses the underlying joint kinematics using the Arm Profile Score (APS). Additionally, the maximum active Range of Motion (aRoM) was measured. Results: Fourteen patients aged 8 to 73 were included. Radiographic findings revealed diverse deformities, including radial head dislocation, interosseous membrane ossification, and radioulnar synostosis. Six patients had mild, six moderate, and two severe deformities of the upper extremity. Severe deformities and radial head dislocation correlated with compromised ROM and worse qDASH scores. The qDASH score ranged from 0 to 37.5 (mean 11.7). APS was increased, and LIF was reduced in OI-affected persons compared with non-affected peers. APS and LIF also varied depending on the severity of bony deformities. aRoM was remarkably reduced for pro-supination. Conclusion: Patients with OI showed variable functional impairment from almost none to severe during daily life activities, mainly depending on the magnitude of deformity in the upper extremity. Larger multicenter studies are needed to confirm the results of this heterogeneous cohort. Level of evidence: Retrospective clinical study; Level IV.

A quantitative comparison between the mHand Adapt passive adjustable hand prosthesis and its predecessor, the Delft Self-Grasping Hand.

The Delft Self-Grasping Hand (SGH) is an adjustable passive hand prosthesis that relies on wrist flexion to adjust the aperture of its grasp. The mechanism requires engagement of the contralateral hand meaning that hand is not available for other tasks. A commercialised version of this prosthesis, known as the mHand Adapt, includes a new release mechanism, which avoids the need to press a release button, and changes to the hand shape. This study is the first of its kind to compare two passive adjustable hand prostheses on the basis of quantitative scoring and contralateral hand involvement. 10 anatomically intact participants were asked to perform the Southampton Hand Assessment Procedure (SHAP) with the mHand. Functionality and contralateral hand involvement were recorded and compared against SGH data originating from a previous trial involving a nearly identical testing regime. mHand exhibited higher functionality scores and less contralateral hand interaction time, especially during release-aiding interactions. Additionally, a wider range of tasks could be completed using the mHand than the SGH. Geometric changes make the mHand more capable of manipulating smaller objects. The altered locking mechanism means some tasks can be performed without any contralateral hand involvement and a higher number of tasks do not require contralateral involvement when releasing. Some participants struggled with achieving a good initial grip due to the inability to tighten the grasp once already formed. The mHand offers the user higher functionality scores with less contralateral hand interaction time and the ability to perform a wider range of tasks. However, there are some design trade-offs which may make it slightly harder to learn to use.

A BIONIC HAND VS. A REPLANTED HAND.

Evaluation of the hand function affected when replacing a malfunctioning hand by a bionic hand. Case report. One individual that wished for a better quality of life after unsatisfying hand function following a replantation. A quantitative and qualitative evaluation of body functions as well as activity performance and participation before and after a planned amputation and prosthetic fitting is presented. Improvements were seen in the patient-reported outcome measures (PROMs) that were used regarding activity (Disability of the Arm, Shoulder and Hand [DASH] and Canadian Occupational Performance Measure [COPM]), pain (Neuropathic Pain Symptom Inventory [NPSI], Brief Pain Inventory [BPI], Visual Analogue Scale [VAS]), cold intolerance (CISS) and health related quality of life (SF-36), as well as in the standardised grip function test, Southampton Hand Assessment Procedure (SHAP). No referred sensations were seen but the discriminative touch on the forearm was improved. In the qualitative interview, a relief of pain, a lack of cold intolerance, improved appearance, better grip function and overall emotional wellbeing were expressed. The planned amputation and subsequent fitting and usage of a hand prosthesis were satisfying for the individual with positive effects on activity and participation. When the hand function after a hand replantation does not reach satisfactory levels, a planned amputation and a prosthetic hand can be the right solution.

An Interactive Digital-Twin Model for Virtual Reality Environments to Train in the Use of a Sensorized Upper-Limb Prosthesis

In recent years, the boost in the development of hardware and software resources for building virtual reality environments has fuelled the development of tools to support training in different disciplines. The purpose of this work is to discuss a complete methodology and the supporting algorithms to develop a virtual reality environment to train the use of a sensorized upper-limb prosthesis targeted at amputees. The environment is based on the definition of a digital twin of a virtual prosthesis, able to communicate with the sensors worn by the user and reproduce its dynamic behaviour and the interaction with virtual objects. Several training tasks are developed according to standards, including the Southampton Hand Assessment Procedure, and the usability of the entire system is evaluated, too.

A content comparison of 4 commonly used adult upper limb amputee outcome measurements with application of the refinements of International Classification of Functioning, Disability, and Health linking rules.

The application of the refinements of linking rules to the outcome measurement methods provides an opportunity to obtain information concerning what the available instruments actually measure and how the instrument measures certain outcomes. The purpose of the study was to analyze the content of 4 commonly used upper limb amputee scales using the refined International Classification of Functioning, Disability, and Health (ICF) linking rules. The Upper Extremity Functional Status module of the Orthotics and Prosthetics User Survey (OPUS-UEFS), Trinity Amputation and Prosthesis Experience Scales, Southampton Hand Assessment Procedure (SHAP), and Quick Disability of the Arm, Shoulder, and Hand were analyzed by 2 health professionals for a content comparison based on ICF categories. The Kappa statistic was used to calculate the degree of agreement between 2 professionals. The scale questions were linked with 43 different ICF codes in this study. Trinity Amputation and Prosthesis Experience Scale addresses all ICF domains. All items of SHAP and most items of OPUS-UEFS were linked to the activity-participation domain. Quick Disability of the Arm, Shoulder, and Hand items were linked with activity-participation and body function domains. The perspectives of OPUS-UEFS and SHAP are descriptive. The perspectives of Quick Disability of the Arm, Shoulder, and Hand were descriptive and appraisal. The perspectives of Trinity Amputation and Prosthesis Experience Scale subscales were descriptive, appraisal, and needs or dependency. Estimated kappa values ranged from 0.44 to 0.91 for ICF codes. Most concepts in the scales were frequently linked to the activity-participation domain. We think that the results of this study will be a useful guide to clinicians and researchers in selecting relevant and appropriate outcome measurements for upper limb amputee rehabilitation.

A Tool to Assist in the Analysis of Gaze Patterns in Upper Limb Prosthetic Use

Gaze-tracking, where the point of regard of a subject is mapped onto the image of the scene the subject sees, can be employed to study the visual attention of the users of prosthetic hands. It can show whether the user pays greater attention to the actions of their prosthetic hand as they use it to perform manipulation tasks, compared with the general population. Conventional analysis of the video data requires a human operator to identify the key areas of interest in every frame of the video data. Computer vision techniques can assist with this process, but fully automatic systems require large training sets. Prosthetic investigations tend to be limited in numbers. However, if the assessment task is well-controlled, it is possible to make a much simpler system that uses the initial input from an operator to identify the areas of interest and then the computer tracks the objects throughout the task. The tool described here employs colour separation and edge detection on images of the visual field to identify the objects to be tracked. To simplify the computer’s task further, this test uses the Southampton Hand Assessment Procedure (SHAP) to define the activity spatially and temporarily, reducing the search space for the computer. The work reported here concerns the development of a software tool capable of identifying and tracking the points of regard and areas of interest throughout an activity with minimum human operator input. Gaze was successfully tracked for fourteen unimpaired subjects and was compared with the gaze of four users of myoelectric hands. The SHAP cutting task is described and the differences in attention observed with a greater number of shorter fixations by the prosthesis users compared to unimpaired subjects. There was less looking ahead to the next phase of the task by the prosthesis users.

The multi-grip and standard myoelectric hand prosthesis compared: does the multi-grip hand live up to its promise?

BackgroundMulti-grip myoelectric hand prostheses (MHPs), with five movable and jointed fingers, have been developed to increase functionality. However, literature comparing MHPs with standard myoelectric hand prostheses (SHPs) is limited and inconclusive. To establish whether MHPs increase functionality, we compared MHPs with SHPs on all categories of the International Classification of Functioning, Disability, and Health-model (ICF-model).MethodsMHP users (N = 14, 64.3% male, mean age = 48.6 years) performed physical measurements (i.e., Refined Clothespin Relocation Test (RCRT), Tray-test, Box and Blocks Test, Southampton Hand Assessment Procedure) with their MHP and an SHP to compare the joint angle coordination and functionality related to the ICF-categories ‘Body Function’ and ‘Activities’ (within-group comparisons). SHP users (N = 19, 68.4% male, mean age = 58.1 years) and MHP users completed questionnaires/scales (i.e., Orthotics and Prosthetics Users’ Survey—The Upper Extremity Functional Status Survey /OPUS–UEFS, Trinity Amputation and Prosthesis Experience Scales for upper extremity/TAPES-Upper, Research and Development-36/RAND-36, EQ-5D-5L, visual analogue scale/VAS, the Dutch version of the Quebec User Evaluation of Satisfaction with assistive technology/D-Quest, patient-reported outcome measure to assess the preferred usage features of upper limb prostheses/PUF-ULP) to compare user experiences and quality of life in the ICF-categories ‘Activities’, ‘Participation’, and ‘Environmental Factors’ (between-group comparisons).Results‘Body Function’ and ‘Activities’: nearly all users of MHPs had similar joint angle coordination patterns with an MHP as when they used an SHP. The RCRT in the upward direction was performed slower in the MHP condition compared to the SHP condition. No other differences in functionality were found. ‘Participation’: MHP users had a lower EQ-5D-5L utility score; experienced more pain or limitations due to pain (i.e., measured with the RAND-36). ‘Environmental Factors’: MHPs scored better than SHPs on the VAS-item holding/shaking hands. The SHP scored better than the MHP on five VAS-items (i.e., noise, grip force, vulnerability, putting clothes on, physical effort to control) and the PUF-ULP.ConclusionMHPs did not show relevant differences in outcomes compared to SHPs on any of the ICF-categories. This underlines the importance of carefully considering whether the MHP is the most suitable option for an individual taking into account the additional costs of MHPs.

Myoelectric prosthesis hand grasp control following targeted muscle reinnervation in individuals with transradial amputation.

Despite the growing availability of multifunctional prosthetic hands, users' control and overall functional abilities with these hands remain limited. The combination of pattern recognition control and targeted muscle reinnervation (TMR) surgery, an innovative technique where amputated nerves are transferred to reinnervate new muscle targets in the residual limb, has been used to improve prosthesis control of individuals with more proximal upper limb amputations (i.e., shoulder disarticulation and transhumeral amputation). The goal of this study was to determine if prosthesis hand grasp control improves following transradial TMR surgery. Eight participants were trained to use a multi-articulating hand prosthesis under myoelectric pattern recognition control. All participated in home usage trials pre- and post-TMR surgery. Upper limb outcome measures were collected following each home trial. Three outcome measures (Southampton Hand Assessment Procedure, Jebsen-Taylor Hand Function Test, and Box and Blocks Test) improved 9-12 months post-TMR surgery compared with pre-surgery measures. The Assessment of Capacity for Myoelectric Control and Activities Measure for Upper Limb Amputees outcome measures had no difference pre- and post-surgery. An offline electromyography analysis showed a decrease in grip classification error post-TMR surgery compared to pre-TMR surgery. Additionally, a majority of subjects noted qualitative improvements in their residual limb and phantom limb sensations post-TMR. The potential for TMR surgery to result in more repeatable muscle contractions, possibly due to the reduction in pain levels and/or changes to phantom limb sensations, may increase functional use of many of the clinically available dexterous prosthetic hands.

Finch: Prosthetic Arm With Three Opposing Fingers Controlled by a Muscle Bulge.

Forearm amputees can use body-powered hooks and myoelectric hands for their daily activities. The body-powered hooks are suitable for delicate manipulation. However, their appearance is not always preferred by amputees, and a harness to pull a control cable is not easy to wear. Although the myoelectric hands have a natural appearance similar to the human hand and can be intuitively controlled by a myoelectric control system, they are not easy to try out and are heavy. This paper reports on the Finch, a prosthetic arm with three opposing fingers controlled by a muscle bulge. The aim of developing the Finch is to realize a lightweight prosthetic arm that is easy to wear and use. Three opposing fingers are controlled according to the degree of muscle bulge measured with a muscle bulge sensor on the user's forearm caused by muscle contraction. A supporter socket, consisting of a resin socket frame and a fabric supporter, allows easy fitting. A simple design using a linear actuator and 3D-printed parts achieved light weight (330 g) and low cost. Six functional tests and user tests using Southampton Hand Assessment Procedure showed that the Finch had a practical function that could be used in daily activities.

Training prosthesis users to switch between modes of a multi-articulating prosthetic hand

Purpose Producing triggers to switch between modes of myoelectric prosthetic hands has proven to be difficult. We evaluated whether digital training methods were feasible in individuals with an upper limb defect (ULD), whether myosignals in these individuals differ from those of non-impaired individuals and whether acquired skills transfer to prosthesis use. Materials and methods Two groups participated in a 9-day pre-test–post-test design study with seven 45-minute training sessions. One group trained using a serious game, the other with their myosignals digitally displayed. Both groups also trained using a prosthesis. The pre- and post-tests consisted of an adapted Clothespin Relocation Test and the spherical subset of the Southampton Hand Assessment Procedure. After the post-test, the System Usability Scale (SUS) was administered. Clinically relevant performance measures and myosignal features were analysed. Results Four individuals with a ULD participated. SUS-scores deemed both training methods feasible. Three participants produced only a few correct triggers. Myosignals features indicated larger variability for individuals with a ULD compared to non-impaired individuals (previously published data [1]). Three participants indicated transfer of skill. Conclusions Even though both training methods were deemed feasible and most participants showed transfer, seven training sessions were insufficient to learn reliable switching behaviour. Trial registration: The study was approved by the medical ethics committee of the University Medical Center Groningen (METc 2018.268). Implications for rehabilitation Switching between pre-programmed modes of a myoelectric prosthetic hand can be learned, however it does require training. Serious games can be considered useful training tools for trigger production in early phases of myoelectric prosthesis control training. In order to evoke transfer of skill from training to daily life both task-specificity and focus of attention during training should be taken into account.

Effect of the Thumb Orientation and Actuation on the Functionality and Performance of Affordable Prosthetic Hands: Obtaining Design Criteria.

The advent of 3D printing technologies has enabled the development of low-cost prosthetic underactuated hands, with cables working as tendons for flexion. Despite the particular relevance to human grasp, its conception in prosthetics is based on vague intuitions of the designers due to the lack of studies on its relevance to the functionality and performance of the device. In this work, some criteria for designers are provided regarding the carpometacarpal joint of the thumb in these devices. To this end, we studied four prosthetic hands of similar characteristics with the motion of abduction/adduction of the thumb resolved in three different ways: fixed at a certain abduction, coupled with the motion of flexion/extension, and actuated independently of the flexion/extension. The functionality and performance of the hands were assessed for the basic grasps using the Anthropomorphic Hand Assessment Protocol (AHAP) and a reduced version of the Southampton Hand Assessment Procedure (SHAP). As a general rule, it seems desirable that thumb adduction/abduction is performed independently of flexion/extension, although this adds one degree of control. If having this additional degree of control is beyond debate, coupled flexion/extension and adduction/abduction should be avoided in favour of the thumb having a fixed slight palmar abduction.

Comparison of patient-reported and functional outcomes after transition from traditional upper limb prosthetics to multiarticulating hands in the user with a unilateral transradial amputation.

Multiarticulating hands (MAHs) have been commercially available for over 15 years. Despite this, their cost remains significantly higher than traditional electric hands, and they are not routinely available in many countries. The Scottish Specialist Prosthetic Service within the National Health Service has been prescribing MAHs since 2014. However, the benefits of MAHs provided in clinical settings are not well known. This study aimed to compare patient-reported and functional measures in unilateral transradial prosthetic users transitioning from a body-powered or traditional myoelectric prosthesis to a MAH. This was a retrospective cohort analysis of individuals with a unilateral transradial amputation provided with a MAH. Of 38 users provided with MAHs, 20 had complete data sets of patient-reported and functional measures before and 6 months after provision. These included Disabilities of the Arm, Shoulder, and Hand; Southampton Hand Assessment Procedure Index of Function; health-related quality of life (EQ-5D-5L Health Index); Trinity Amputation and Prosthesis Experience Scales satisfaction; and Box and Block Test. The mean age was 44 years (SD 16) (n = 20), and 75% were male. There were an 8-unit mean reduction in the Disabilities of the Arm, Shoulder, and Hand ( P = .01) and a 9.5-unit improvement in the Southampton Hand Assessment Procedure IOF ( P = .007) at 6 months after provision. Health-related quality of life did not change ( P = .581). Users reported a four-point improvement in their Trinity Amputation and Prosthesis Experience Scales ( P = .004) and transferred 3.3 blocks more completing the Box and Block Test ( P = .001). The evidence clearly supports continued provision of MAHs to this group of moderate users: the more function the user achieves, the less of a disability they perceive to have.

Improvements in hand functions and changes in proximal muscle activities in myoelectric prosthetic hand users at home: a case series.

Adaptation in proximal muscles for daily motor tasks after sustained use of a prosthetic hand has not been fully understood. This study aimed to investigate changes in hand functions and activities of proximal muscles after multiple weeks of using a myoelectric prosthetic hand at home. Repeated measures. Four people with traumatic upper-limb loss used a myoelectric prosthetic hand (bebionic) at home over the 6- to 8-week period. A user survey, Orthotics and Prosthetics User Survey for Upper Extremity Functional Status 2.0, was used to measure upper-limb functions and the degree of using the prosthetic hand each week. Their hand functions, muscle activities, and grip-specific neuromuscular effort were evaluated by the Southampton Hand Assessment Procedure at the preassessment and postassessment sessions (PRE and POST, respectively). All subjects increased Southampton Hand Assessment Procedure scores at PRE compared with POST with subject-specific changes in muscle activations. In a detail, at POST, subject 1 reduced the shoulder muscle activity compared with PRE, while at POST, subject 2 reduced biceps activity compared with PRE. At POST, greater pectoralis activity and reduced trapezius activity were observed in subject 3, and greater activity in those two muscles was found in subject 4 compared with PRE. After multiple weeks of using the myoelectric prosthetic hands, their hand functions during ADL tasks were improved and changes in the muscle activities were found.

Actual prosthetic usage in relation to functional outcomes and wearing time in individuals with below-elbow amputation.

Wearing time of a prosthesis is regarded as an indicator for success of prosthetic rehabilitation. However, prostheses are frequently worn for esthetic purposes only. Although different supervised measurements to assess prosthetic dexterity are used, it is not clear how performance in such tests translates into actual use in everyday life. To evaluate the actual daily use of the prosthetic device in patients with below-elbow amputations by recording the number of grasping motions. Observational study. Upper extremity function was evaluated using different objective and timed assessments in five unilateral patients with below-elbow amputations. In addition, patients reported daily wearing time, and the number of performed prosthetic movements over a period of at least three months was recorded. The patients achieved a mean Southampton Hand Assessment Procedure score of 66.60 ± 18.64 points. The average blocks moved in the Box and Block Test were 20.80 ± 7.46, and the mean score in the Action Research Arm Test was 37.20 ± 5.45. The mean time for the Clothespin-Relocation Test was 26.90 ± 11.61 seconds. The patients reported a wearing time of an average of 12.80 ± 3.11 hours per day. The mean number of prosthetic motions performed each day was 257.23 ± 192.95 with a range from 23.07 to 489.13. Neither high functionality nor long wearing times necessitated frequent use of a prosthesis in daily life. However, frequent daily motions did translate into good functional scores, indicating that regular device use in different real-life settings relates to functionality.

Upper-Limb Electromyogram Classification of Reaching-to-Grasping Tasks Based on Convolutional Neural Networks for Control of a Prosthetic Hand.

In recent years, myoelectric interfaces using surface electromyogram (EMG) signals have been developed for assisting people with physical disabilities. Especially, in the myoelectric interfaces for robotic hands or arms, decoding the user’s upper-limb movement intentions is cardinal to properly control the prosthesis. However, because previous experiments were implemented with only healthy subjects, the possibility of classifying reaching-to-grasping based on the EMG signals from the residual limb without the below-elbow muscles was not investigated yet. Therefore, we aimed to investigate the possibility of classifying reaching-to-grasping tasks using the EMG from the upper arm and upper body without considering wrist muscles for prosthetic users. In our study, seven healthy subjects, one trans-radial amputee, and one wrist amputee were participated and performed 10 repeatable 12 reaching-to-grasping tasks based on the Southampton Hand Assessment Procedure (SHAP) with 12 different weighted (light and heavy) objects. The acquired EMG was processed using the principal component analysis (PCA) and convolutional neural network (CNN) to decode the tasks. The PCA–CNN method showed that the average accuracies of the healthy subjects were 69.4 ± 11.4%, using only the EMG signals by the upper arm and upper body. The result with the PCA–CNN method showed 8% significantly higher accuracies than the result with the widely used time domain and auto-regressive-support vector machine (TDAR–SVM) method as 61.6 ± 13.7%. However, in the cases of the amputees, the PCA–CNN showed slightly lower performance. In addition, in the aspects of assistant daily living, because grip force is also important when grasping an object after reaching, the possibility of classifying the two light and heavy objects in each reaching-to-grasping task was also investigated. Consequently, the PCA–CNN method showed higher accuracy at 70.1 ± 9.8%. Based on our results, the PCA–CNN method can help to improve the performance of classifying reaching-to-grasping tasks without wrist EMG signals. Our findings and decoding method can be implemented to further develop a practical human–machine interface using EMG signals.

Affordable 3D-printed tendon prosthetic hands: Expectations and benchmarking questioned

The popularization of 3D-printing has allowed enhancing affordable prostheses for persons with amputations in developing countries, yet manufacturers are not subjected to any control from any medical regulatory authority. Adopted evaluation protocols seem to cherish optimistic expectations. A reduced performance test, derived from the Southampton Hand Assessment Procedure and two bench tests, to evaluate the mechanical advantage in the fingers and the slip resistance, are proposed to assess affordable tendon-driven devices. Ultimately, five models amongst those most commonly found in the scientific literature and the Internet have been evaluated. Three subjects participated with the aid of an able-bodied adaptor. The reduced test of performance provides consistent results but with a more direct interpretation of the failed patterns of prehension. All these models create far more expectations than the results deliver. With the supplementary material provided, an affordable benchmarking can be established with this reduced performance test and the two bench tests. They can lead to improved designs, prescriptions and regulations.

Psychometric evaluation of the Southampton hand assessment procedure (SHAP) in a sample of upper limb prosthesis users

BackgroundThe 26-item Southampton Hand Assessment Protocol (SHAP) is a test of prosthetic hand function that generates an Index of Functionality (IOF), and prehensile pattern (PP) scores. Prior researchers identified potential issues in SHAP scoring, proposing alternative scoring methods (LIF and W-LIF). Study designCross-sectional study. PurposeEvaluate the psychometric properties of the SHAP IOF, LIF, and W-LIF and PP scores and develop the Prosthesis Index of Functionality (P-IOF). MethodsWe examined item completion, floor andceiling effects, concurrent, discriminant, construct and structural validity. The P-IOF used increased boundary limits and information from item completion and completion time. Calibration used a nonlinear mixed model. Scores were estimated using maximum a posteriori Bayesian estimation. Mixed integer linear programing (MILP) informed development of a shorter measure. Validity analyses were repeated using the P-IOF. Results126 persons, mean age 57 (sd 15.8), 69% with transradial amputation were included. Floors effects were observed in 18.3%-19.1% for the IOF, LIF, and W-LIF. Ten items were not completed by >15% of participants. Boundary limits were problematic for all but 1 item. Correlations with dexterity measures were strong (r = 0.54-0.73). Scores differed by amputation level (p > .0001). Factor analysis did not support use of PP scores. The P-IOF used expanded boundary limits to decrease floor effects. MILP identified 10 items that could be dropped. The 26-item P-IOF and 16-item P-IOF had reduced floor effects (<7.5%), strong evidence of concurrent and discriminant validity, and construct validity. P-IOF reduced administrative burden by 9.5 (sd 5.6) minutes. DiscussionFloor effects limit a measure's ability to distinguish between persons with low function. ConclusionAnalyses supported the validity of the SHAP IOF, LIF, and W-LIF, but identified large floor effects, as well as issues with structural validity of the PP scores. The 16-item P-IOF minimizes floor effects and reduces administrative burden.

An evaluation of contralateral hand involvement in the operation of the Delft Self-Grasping Hand, an adjustable passive prosthesis.

The Delft Self-Grasping Hand is an adjustable passive prosthesis operated using the concept of tenodesis (where opening and closing of the hand is mechanically linked to the flexion and extension of the wrist). As a purely mechanical device that does not require harnessing, the Self-Grasping Hand offers a promising alternative to current prostheses. However, the contralateral hand is almost always required to operate the mechanism to release a grasp and is sometimes also used to help form the grasp; hence limiting the time it is available for other purposes. In this study we quantified the amount of time the contralateral hand was occupied with operating the Self-Grasping Hand, classified as either direct or indirect interaction, and investigated how these periods changed with practice. We studied 10 anatomically intact participants learning to use the Self-Grasping Hand fitted to a prosthesis simulator. The learning process involved 10 repeats of a feasible subset of the tasks in the Southampton Hand Assessment Procedure (SHAP). Video footage was analysed, and the time that the contralateral hand was engaged in grasping or releasing was calculated. Functionality scores increased for all participants, plateauing at an Index of Functionality of 33.5 after 5 SHAP attempts. Contralateral hand involvement reduced significantly from 6.47 (first 3 attempts) to 4.68 seconds (last three attempts), but as a proportion of total task time remained relatively steady (increasing from 29% to 32%). For 9/10 participants most of this time was supporting the initiation of grasps rather than releases. The reliance on direct or indirect interactions between the contralateral hand and the prosthesis varied between participants but appeared to remain relatively unchanged with practice. Future studies should consider evaluating the impact of reliance on the contralateral limb in day-to-day life and development of suitable training methods.

Classification of 41 Hand and Wrist Movements via Surface Electromyogram Using Deep Neural Network

Surface electromyography (sEMG) is a non-invasive and straightforward way to allow the user to actively control the prosthesis. However, results reported by previous studies on using sEMG for hand and wrist movement classification vary by a large margin, due to several factors including but not limited to the number of classes and the acquisition protocol. The objective of this paper is to investigate the deep neural network approach on the classification of 41 hand and wrist movements based on the sEMG signal. The proposed models were trained and evaluated using the publicly available database from the Ninapro project, one of the largest public sEMG databases for advanced hand myoelectric prosthetics. Two datasets, DB5 with a low-cost 16 channels and 200 Hz sampling rate setup and DB7 with 12 channels and 2 kHz sampling rate setup, were used for this study. Our approach achieved an overall accuracy of 93.87 ± 1.49 and 91.69 ± 4.68% with a balanced accuracy of 84.00 ± 3.40 and 84.66 ± 4.78% for DB5 and DB7, respectively. We also observed a performance gain when considering only a subset of the movements, namely the six main hand movements based on six prehensile patterns from the Southampton Hand Assessment Procedure (SHAP), a clinically validated hand functional assessment protocol. Classification on only the SHAP movements in DB5 attained an overall accuracy of 98.82 ± 0.58% with a balanced accuracy of 94.48 ± 2.55%. With the same set of movements, our model also achieved an overall accuracy of 99.00% with a balanced accuracy of 91.27% on data from one of the amputee participants in DB7. These results suggest that with more data on the amputee subjects, our proposal could be a promising approach for controlling versatile prosthetic hands with a wide range of predefined hand and wrist movements.

User training for machine learning controlled upper limb prostheses: a serious game approach

BackgroundUpper limb prosthetics with multiple degrees of freedom (DoFs) are still mostly operated through the clinical standard Direct Control scheme. Machine learning control, on the other hand, allows controlling multiple DoFs although it requires separable and consistent electromyogram (EMG) patterns. Whereas user training can improve EMG pattern quality, conventional training methods might limit user potential. Training with serious games might lead to higher quality EMG patterns and better functional outcomes. In this explorative study we compare outcomes of serious game training with conventional training, and machine learning control with the users’ own one DoF prosthesis.MethodsParticipants with upper limb absence participated in 7 training sessions where they learned to control a 3 DoF prosthesis with two grips which was fitted. Participants received either game training or conventional training. Conventional training was based on coaching, as described in the literature. Game-based training was conducted using two games that trained EMG pattern separability and functional use. Both groups also trained functional use with the prosthesis donned. The prosthesis system was controlled using a neural network regressor. Outcome measures were EMG metrics, number of DoFs used, the spherical subset of the Southampton Hand Assessment Procedure and the Clothespin Relocation Test.ResultsEight participants were recruited and four completed the study. Training did not lead to consistent improvements in EMG pattern quality or functional use, but some participants improved in some metrics. No differences were observed between the groups. Participants achieved consistently better results using their own prosthesis than the machine-learning controlled prosthesis used in this study.ConclusionOur explorative study showed in a small group of participants that serious game training seems to achieve similar results as conventional training. No consistent improvements were found in either group in terms of EMG metrics or functional use, which might be due to insufficient training. This study highlights the need for more research in user training for machine learning controlled prosthetics. In addition, this study contributes with more data comparing machine learning controlled prosthetics with Direct Controlled prosthetics.