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. 2016 Oct 7;13(1):90.
doi: 10.1186/s12984-016-0197-7.

Learning to Use a Body-Powered Prosthesis: Changes in Functionality and Kinematics

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Free PMC article

Learning to Use a Body-Powered Prosthesis: Changes in Functionality and Kinematics

Laura H B Huinink et al. J Neuroeng Rehabil. .
Free PMC article

Abstract

Background: Little is known about action-perception learning processes underlying prosthetic skills in body-powered prosthesis users. Body-powered prostheses are controlled through a harness connected by a cable that might provide for limited proprioceptive feedback. This study aims to test transfer of training basic tasks to functional tasks and to describe the changes over time in kinematics of basic tasks of novice body-powered prosthesis users.

Methods: Thirty able-bodied participants and 17 controls participated in the study, using a body-powered prosthetic simulator. Participants in the training group were divided over four groups and practiced during a 2-week-period either direct grasping, indirect grasping, fixation, or a combination of these tasks. Deformable objects with different compliances had to be manipulated while kinematic variables and grip force control were assessed. Functional performance was measured with the Southampton Hand Assessment Procedure (SHAP) prior to and after the training sessions, and after 2 weeks and 3 months retention. The control group only performed the SHAP tests.

Results: All four training groups and the control group improved on the SHAP, also after a period of non-use. Type of training had a small but significant influence on the improvements of the SHAP score. On a kinematic level movement times decreased and hook closing velocities increased over time. The indirect grasping group showed significantly shorter plateau times than the other training groups. Grip force control only improved a little over training.

Conclusions: Training action-perception couplings of body-powered prosthesis in basic tasks transferred to functional tasks and this lasted after a period of non-use. During training movement times decreased and the indirect grasping group showed advantages. It is advisable to start body-powered training with indirect grasping tasks but also to practice hook-object orientations.

Keywords: Action-perception; Amputee; Body-powered prosthetic hook; Functional performance; Grip force control; Kinematics; Proprioceptive feedback; Prosthetic training; Upper-limb prosthesis.

Figures

Fig. 1
Fig. 1
a The body-powered simulator. b The figure-of-9-harness wrapped around the contralateral shoulder
Fig. 2
Fig. 2
a A deformable object consisting of two plates with a spring in between and with a Velcro strip mounted on top. b A deformable object grasped with the prosthesis
Fig. 3
Fig. 3
Experimental set-up. S = Session
Fig. 4
Fig. 4
Index of Functionality scores of the SHAP. a Means (+/−SD) of the IoF scores are shown for the four training groups (FIX, COM, IG, DG) and the control group on pretest, posttest, retention test after 2 weeks (RT1) and retention test after 3 months (RT2). Higher scores indicate a better performance. b The difference between the IoF scores of the control group and each of the experimental group is plotted for each of the experimental groups at each measurement moment
Fig. 5
Fig. 5
Example of a direct grasping trial with a low-resistance object. a Reach velocity of the hook, b hook aperture and, c the deformation of the object are plotted against the time. Several kinematic variables are represented by a = Reach time, b = Plateau time, c = Hook closing time, d = Compression at moment of grasp, e = Compression during manipulation

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