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BACKGROUND: Transfemoral amputees experience a complex host of physical, psychological, and social challenges, compounded by the functional limitations of current transfemoral prostheses. However, the specific relationships between human factors and prosthesis design and performance characteristics have not yet been adequately investigated. The present study aims to address this knowledge gap. METHODS: A comprehensive single-cohort survey of 114 unilateral transfemoral amputees addressed a broad range of demographic and clinical characteristics, functional autonomy, satisfaction and attitudes towards their current prostheses, and design priorities for an ideal transfemoral prosthesis, including the possibility of active assistance from a robotic knee unit. The survey was custom-developed based on several standard questionnaires used to assess motor abilities and autonomy in activities of daily living, prosthesis satisfaction, and quality of life in lower-limb amputees. Survey data were analyzed to compare the experience (including autonomy and satisfaction) and design priorities of users of transfemoral prostheses with versus without microprocessor-controlled knee units (MPKs and NMPKs, respectively), with a subsequent analyses of cross-category correlation, principal component analysis (PCA), cost-sensitivity segmentation, and unsupervised K-means clustering applied within the most cost-sensitive participants, to identify functional groupings of users with respect to their design priorities. RESULTS: The cohort featured predominantly younger (< 50 years) traumatic male amputees with respect to the general transfemoral amputee population, with pronounced differences in age distribution and amputation etiology (traumatic vs. non-traumatic) between MPK and NMPK groups. These differences were further reflected in user experience, with MPK users reporting significantly greater overall functional autonomy, satisfaction, and sense of prosthesis ownership than those with NMPKs, in conjunction with a decreased incidence of instability and falls. Across all participants, the leading functional priorities for an ideal transfemoral prosthesis were overall stability, adaptability to variable walking velocity, and lifestyle-related functionality, while the highest-prioritized general characteristics were reliability, comfort, and weight, with highly variable prioritization of cost according to reimbursement status. PCA and user clustering analyses revealed the possibility for functionally relevant groupings of prosthesis features and users, based on their differential prioritization of these features-with implications towards prosthesis design tradeoffs. CONCLUSIONS: This study's findings support the understanding that when appropriately prescribed according to patient characteristics and needs in the context of a proactive rehabilitation program, advanced transfemoral prostheses promote patient mobility, autonomy, and overall health. Survey data indicate overall stability, modularity, and versatility as key design priorities for the continued development of transfemoral prosthesis technology. Finally, observed associations between prosthesis type, user experience, and attitudes concerning prosthesis ownership suggest both that prosthesis characteristics influence device acceptance and functional outcomes, and that psychosocial factors should be specifically and proactively addressed during the rehabilitation process.
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Amputados , Membros Artificiais , Procedimentos Cirúrgicos Robóticos , Atividades Cotidianas , Amputação Cirúrgica , Amputados/reabilitação , Humanos , Masculino , Desenho de Prótese , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários , Design Centrado no Usuário , CaminhadaRESUMO
Urinary incontinence affects more than 300 million people worldwide. The implantation of a medical device called an artificial urinary sphincter (AUS) is the gold standard treatment when conservative and minimally invasive therapies fail. In this article, the AUSs (extra-urethral and endo-urethral sphincters) available on the market, both presented at the research level and filed as patents, are reviewed. The ability of the different solutions to effectively replace the natural sphincter are discussed, together with advantages and some possible side effects, such as tissue atrophy, overall invasiveness of the implant, and so forth. Finally, future research priorities are discussed for both endo-urethral and extra-urethral approaches considering key engineering aspects, such as materials, compression and closure mechanisms, and implantation methods, with the long-term aim of developing an effective, reliable, durable, and minimally invasive AUS capable of restoring a normal quality of life for incontinent patients.
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Implantação de Prótese , Qualidade de Vida , Incontinência Urinária/cirurgia , Esfíncter Urinário Artificial , Humanos , Resultado do TratamentoRESUMO
To provide upper-limb amputees with devices that best fit their needs and to test innovative solutions, it is necessary to quantitatively appraise a device performance with rigorous measurement methods. The aim of this work was to define an optimal motion analysis protocol, suitable for optoelectronic systems, to measure the kinematics of poly-articulated hands even when covered by a cosmetic glove. This is a fundamental aspect, because gloves can decrease device speed and range of motion and, ultimately, patients' acceptance of the artificial limb. In this work, different mathematical models of the joints and marker-sets for motion analysis were conceived. A regression model to choose a reduced marker-set for studying the hand performance with different cosmetic glove models was developed. The proposed approaches for finger motion analysis were experimentally tested on the index finger of the i-Limb, a commercial myoelectric poly-articulated prosthetic hand, but the results can be easily extended to the whole hand and to other poly-articulated prosthetic hands. The methods proposed for the performance analysis of prosthetic hands points out that the cosmetic gloves imply a reduction of the finger flexion/extension (F/E) angles and of the motion velocity. This draws attention to the need for performing independent cyclic tests on commercial products with various cosmetic solutions to better guide component selection.
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Membros Artificiais , Mãos , Algoritmos , Fenômenos Biomecânicos , Luvas Protetoras , Mãos/anatomia & histologia , Mãos/fisiologia , Humanos , Modelos Biológicos , Movimento (Física) , Desenho de Prótese , Amplitude de Movimento ArticularRESUMO
BACKGROUND: Currently, the typically adopted hand prosthesis surface electromyography (sEMG) control strategies do not provide the users with a natural control feeling and do not exploit all the potential of commercially available multi-fingered hand prostheses. Pattern recognition and machine learning techniques applied to sEMG can be effective for a natural control based on the residual muscles contraction of amputated people corresponding to phantom limb movements. As the researches has reached an advanced grade accuracy, these algorithms have been proved and the embedding is necessary for the realization of prosthetic devices. The aim of this work is to provide engineering tools and indications on how to choose the most suitable classifier, and its specific internal settings for an embedded control of multigrip hand prostheses. METHODS: By means of an innovative statistical analysis, we compare 4 different classifiers: Nonlinear Logistic Regression, Multi-Layer Perceptron, Support Vector Machine and Linear Discriminant Analysis, which was considered as ground truth. Experimental tests have been performed on sEMG data collected from 30 people with trans-radial amputation, in which the algorithms were evaluated for both performance and computational burden, then the statistical analysis has been based on the Wilcoxon Signed-Rank test and statistical significance was considered at p < 0.05. RESULTS: The comparative analysis among NLR, MLP and SVM shows that, for either classification performance and for the number of classification parameters, SVM attains the highest values followed by MLP, and then by NLR. However, using as unique constraint to evaluate the maximum acceptable complexity of each classifier one of the typically available memory of a high performance microcontroller, the comparison pointed out that for people with trans-radial amputation the algorithm that produces the best compromise is NLR closely followed by MLP. This result was also confirmed by the comparison with LDA with time domain features, which provided not significant differences of performance and computational burden between NLR and LDA. CONCLUSIONS: The proposed analysis would provide innovative engineering tools and indications on how to choose the most suitable classifier based on the application and the desired results for prostheses control.
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Algoritmos , Membros Artificiais , Bioengenharia/métodos , Eletromiografia/métodos , Reconhecimento Automatizado de Padrão/métodos , Amputados , Análise Discriminante , Dedos/fisiologia , Mãos/fisiologia , Humanos , Movimento/fisiologia , Máquina de Vetores de SuporteRESUMO
The analysis of the human grasping and manipulation capabilities is paramount for investigating human sensory-motor control and developing prosthetic and robotic hands resembling the human ones. A viable solution to perform this analysis is to develop instrumented objects measuring the interaction forces with the hand. In this context, the performance of the sensors embedded in the objects is crucial. This paper focuses on the experimental characterization of a class of capacitive pressure sensors suitable for biomechanical analysis. The analysis was performed in three loading conditions (Distributed load, 9 Tips load, and Wave-shaped load, thanks to three different inter-elements) via a traction/compression testing machine. Sensor assessment was also carried out under human- like grasping condition by placing a silicon material with the same properties of prosthetic cosmetic gloves in between the sensor and the inter-element in order to simulate the human skin. Data show that the input-output relationship of the analyzed, sensor is strongly influenced by both the loading condition (i.e., type of inter-element) and the grasping condition (with or without the silicon material). This needs to be taken into account to avoid significant measurement error. To go over this hurdle, the sensors have to be calibrated under each specific condition in order to apply suitable corrections to the sensor output and significantly improve the measurement accuracy.
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Força da Mão , Luvas Protetoras , Mãos , Humanos , RobóticaRESUMO
Clinical gait analysis (CGA) has shown potentials for the prosthetics field and has been found effective for scientific purposes and to design general rehabilitation models. However, intrinsic limitations of the "artificial" laboratory environment usually result in recording performances not representative patients' real-life gait. In order to promote the diffusion of CGA in the clinical decision-making process, a framework for developing novel, more ecological CGA applications is presented. Moreover, the Outwalk protocol, based on wearable sensors and developed within this framework guidelines, is described and validated for its inter-rater agreement on a population of transtibial amputees walking in a real-life scenario. Results show the possibility of drawing precise conclusions over different aspects of amputees' gait and prostheses' performance in every-day life conditions.
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Amputados/reabilitação , Membros Artificiais , Marcha , Humanos , Perna (Membro) , CaminhadaRESUMO
This study aimed to explore the application of infrared thermography in combination with ambulatory wearable monitoring of temperature and relative humidity, to assess the residual limb-to-liner interface in lower-limb prosthesis users. Five male traumatic transtibial amputees were involved, who reported no problems or discomfort while wearing the prosthesis. A thermal imaging camera was used to measure superficial thermal distribution maps of the stump. A wearable system for recording the temperature and relative humidity in up to four anatomical points was developed, tested in vitro and integrated with the measurement set. The parallel application of an infrared camera and wearable sensors provided complementary information. Four main Regions of Interest were identified on the stump (inferior patella, lateral/medial epicondyles, tibial tuberosity), with good inter-subject repeatability. An average increase of 20% in hot areas (P < 0.05) is shown after walking compared to resting conditions. The sensors inside the cuff did not provoke any discomfort during recordings and provide an inside of the thermal exchanges while walking and recording the temperature increase (a regime value is ~+1.1 ± 0.7 °C) and a more significant one (~+4.1 ± 2.3%) in humidity because of the sweat produced. This study has also begun the development of a reference data set for optimal socket/liner-stump construction.
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Membros Artificiais , Telemetria/instrumentação , Termografia/instrumentação , Adulto , Calibragem , Humanos , Umidade , Processamento de Imagem Assistida por Computador , Masculino , Temperatura , Interface Usuário-ComputadorRESUMO
Objective.Powered lower-limb prostheses relying on decoding motor intentions from non-invasive sensors, like electromyographic (EMG) signals, can significantly improve the quality of life of amputee subjects. However, the optimal combination of high decoding performance and minimal set-up burden is yet to be determined. Here we propose an efficient decoding approach obtaining high decoding performance by observing only a fraction of the gait duration with a limited number of recording sites.Approach.Thirteen transfemoral amputee subjects performed five motor tasks while recording EMG signals from four muscles and inertial signals from the prosthesis. A support-vector-machine-based algorithm decoded the gait modality selected by the patient from a finite set. We investigated the trade-off between the robustness of the classifier's accuracy and the minimization of (i) the duration of the observation window, (ii) the number of EMG recording sites, (iii) the computational load of the procedure, measured the complexity of the algorithm.Main results.When including pre-foot-strike data in the decoding, the combination of three EMG recording sites and the inertial signals led to correct rates above 94% at the 20% of the gait cycle, showing the best trade-off between invasiveness of the setup and accuracy of the classifier. The complexity of the algorithm proved to be significantly higher when applying a polynomial kernel compared to a linear one, while the correct rate of the classifier generally showed no differences between the two approaches. The proposed algorithm led to high performance with a minimal EMG set-up and using only a fraction of the gait duration.Significance. These results pave the way for efficient control of powered lower-limb prostheses with minimal set-up burden and a rapid classification output.
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Amputados , Membros Artificiais , Humanos , Qualidade de Vida , Eletromiografia/métodos , Caminhada/fisiologia , Marcha/fisiologia , AlgoritmosRESUMO
For decades, powered exoskeletons have been considered for possible employment in rehabilitation and personal use. Yet, these devices are still far from addressing the needs of users. Here, we introduce TWIN, a novel modular lower limb exoskeleton for personal use of spinal-cord injury (SCI) subjects. This system was designed according to a set of user requirements (lightweight and autonomous portability, quick and autonomous donning and setup, stability when standing/walking, cost effectiveness, long battery life, comfort, safety) which emerged during participatory investigations that organically involved patients, engineers, designers, physiatrists, and physical therapists from two major rehabilitation centers in Italy. As a result of this user-centered process, TWIN's design is based on a variety of small mechatronic modules which are meant to be easily assembled and donned on or off by the user in full autonomy. This paper presents the development of TWIN, an exoskeleton for personal use of SCI users, and the application of user-centered design methods that are typically adopted in medical device industry, for its development. We can state that this approach revealed to be extremely effective and insightful to direct and continuously adapt design goals and activities toward the addressment of user needs, which led to the development of an exoskeleton with modular mechatronics and novel lateral quick release systems. Additionally, this work includes the preliminary assessment of this exoskeleton, which involved healthy volunteers and a complete SCI patient. Tests validated the mechatronics of TWIN and emphasized its high potential in terms of system usability for its intended use. These tests followed procedures defined in existing standards in usability engineering and were part of the formative evaluation of TWIN as a premise to the summative evaluation of its usability as medical device.
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Sense of presence (SoP) has recently emerged as one of the key elements promoting the effectiveness of virtual reality-based training programs. In the context of wheelchair simulators (WSs), the effectiveness of the simulation has been sought using different perception and interaction devices, providing the end-users with different levels of SoP. We performed a scoping review searching scientific and grey literature databases with the aim of assessing the extent of published research dealing with SoP and effectiveness of WSs. Sixty-two articles, describing 29 WSs, were included in the review. In spite of promising results, the high heterogeneity of the employed technological solutions, of the training programs and of their outcomes precluded drawing definitive conclusions about the optimal solution for the enhancement of SoP and thus of WSs' effectiveness. Future research should focus on controlled trials in order to help researchers in assessing the most suitable technologies and methodologies for the application of WSs in clinical practice.
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Simulação por Computador , Treinamento por Simulação , Realidade Virtual , Cadeiras de Rodas , Retroalimentação , Humanos , Tato , Interface Usuário-ComputadorRESUMO
Embodiment is the percept that something not originally belonging to the self becomes part of the body. Feeling embodiment for a prosthesis may counteract amputees' altered image of the body and increase prosthesis acceptability. Prosthesis embodiment has been studied longitudinally in an amputee receiving feedback through intraneural and perineural multichannel electrodes implanted in her stump. Three factors-invasive (vs non-invasive) stimulation, training, and anthropomorphism-have been tested through two multisensory integration tasks: visuo-tactile integration (VTI) and crossing-hand effect in temporal order judgment (TOJ), the former more sensible to an extension of a safe margin around the body and the latter to action-oriented remapping. Results from the amputee participant were compared with the ones from healthy controls. Testing the participant with intraneural stimulation produced an extension of peripersonal space, a sign of prosthesis embodiment. One-month training extended the peripersonal space selectively on the side wearing the prostheses. More and less-anthropomorphic prostheses benefited of intraneural feedback and extended the peripersonal space. However, the worsening of TOJ performance following arm crossing was present only wearing the more trained, despite less anthropomorphic, prosthesis, suggesting that training was critical for our participant to achieve operative tool-like embodiment.
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BACKGROUND: This paper proposes a new approach for neural control of hand prostheses, grounded on pattern recognition applied to the envelope of neural signals (eENG). NEW METHOD: The ENG envelope was computed by taking into account the amplitude and the occurrence of the spike in the neural recording. A pattern recognition algorithm applied on muscular signals was defined as a reference and a comparative analysis with traditionally adopted Spike Sorting Algorithms (SSA) for neural signals has been carried out. Method validation was divided in two parts: firstly, neural signals recorded from one amputee subject through intraneural electrodes were offline analyzed to discriminate between the two performed gestures; secondly, algorithm performance decay with the increase of the number of classes was studied through synthetic data. RESULTS: An accuracy of 98.26% with real data was reached with the pattern recognition applied to eENG. SSA reached an accuracy of 70%. Increasing the number of classes worsens the accuracy of this algorithm. Additionally, computational time for the pattern recognition applied to eENG is very low (32.6⯵s for each sample in the data window analyzed). COMPARISON WITH EXISTING METHOD: The eENG was proved to be more reliable in decoding the user intention than the SSA algorithm and it is computationally efficient. CONCLUSIONS: It was demonstrated that it is possible to apply the well-known techniques of EMG pattern recognition to a conveniently processed neural signal and can pave the way to the application of neural gesture decoding in upper limb prosthetics.
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Membros Artificiais , Eletromiografia/métodos , Mãos/fisiopatologia , Movimento/fisiologia , Reconhecimento Automatizado de Padrão/métodos , Processamento de Sinais Assistido por Computador , Algoritmos , Mãos/inervação , Humanos , Masculino , Nervo Mediano/fisiopatologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Máquina de Vetores de Suporte , Nervo Ulnar/fisiopatologiaRESUMO
Surface electromyography (sEMG) signals represent a promising approach for decoding the motor intention of amputees to control a multifunctional prosthetic hand in a non-invasive way. Several approaches based on proportional amplitude methods or simple thresholds on sEMG signals have been proposed to control a single degree of freedom at time, without the possibility of increasing the number of controllable multiple DoFs in a natural manner. Myoelectric control based on PR techniques have been introduced to add multiple DoFs by keeping low the number of electrodes and allowing the discrimination of different muscular patterns for each class of motion. However, the use of PR algorithms to simultaneously decode both gestures and forces has never been studied deeply. This paper introduces a hierarchical classification approach with the aim to assess the desired hand/wrist gestures, as well as the desired force levels to exert during grasping tasks. A Finite State Machine was introduced to manage and coordinate three classifiers based on the Non-Linear Logistic Regression algorithm. The classification architecture was evaluated across 31 healthy subjects. The "hand/wrist gestures classifier," introduced for the discrimination of seven hand/wrist gestures, presented a mean classification accuracy of 98.78%, while the "Spherical and Tip force classifier," created for the identification of three force levels, reached an average accuracy of 98.80 and 96.09%, respectively. These results were confirmed by Linear Discriminant Analysis (LDA) with time domain features extraction, considered as ground truth for the final validation of the performed analysis. A Wilcoxon Signed-Rank test was carried out for the statistical analysis of comparison between NLR and LDA and statistical significance was considered at p < 0.05. The comparative analysis reports not statistically significant differences in terms of F1Score performance between NLR and LDA. Thus, this study reveals that the use of non-linear classification algorithm, as NLR, is as much suitable as the benchmark LDA classifier for implementing an EMG pattern recognition system, able both to decode hand/wrist gestures and to associate different performed force levels to grasping actions.
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Despite previous studies on the restoration of tactile sensation on the fingers and the hand, there are no examples of use of the routed sensory information to finely control the prosthesis hand in complex grasp and manipulation tasks. Here it is shown that force and slippage sensations can be elicited in an amputee subject by means of biologically-inspired slippage detection and encoding algorithms, supported by a stick-slip model of the performed grasp. A combination of cuff and intraneural electrodes was implanted for eleven weeks in a young woman with hand amputation, and was shown to provide close-to-natural force and slippage sensations, paramount for significantly improving the subject's manipulative skills with the prosthesis. Evidence is provided about the improvement of the subject's grasping and manipulation capabilities over time, thanks to neural feedback. The elicited tactile sensations enabled the successful fulfillment of fine grasp and manipulation tasks with increasing complexity. Grasp performance was quantitatively assessed by means of instrumented objects and a purposely developed metrics. Closed-loop control capabilities enabled by the neural feedback were compared to those achieved without feedback. Further, the work investigates whether the described amelioration of motor performance in dexterous tasks had as central neurophysiological correlates changes in motor cortex plasticity and whether such changes were of purely motor origin, or else the effect of a strong and persistent drive of the sensory feedback.
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Inertial and magnetic measurement systems (IMMSs) are a new generation of motion analysis systems which may diffuse the measurement of upper-limb kinematics to ambulatory settings. Based on the MT9B IMMS (Xsens Technologies, NL), we therefore developed a protocol that measures the scapulothoracic, humerothoracic and elbow 3D kinematics. To preliminarily evaluate the protocol, a 23-year-old subject performed six tasks involving shoulder and elbow single-joint-angle movements. Criteria for protocol validity were limited cross-talk with the other joint-angles during each task; scapulohumeral-rhythm close to literature results; and constant carrying-angle. To assess the accuracy of the MT9B when measuring the upper-limb kinematics through the protocol, we compared the MT9B estimations during the six tasks, plus other four, with the estimations of an optoelectronic system (the gold standard), in terms of RMS error, correlation coefficient (r), and the amplitude ratio (m). Results indicate that the criteria for protocol validity were met for all tasks. For the joint angles mainly involved in each movement, the MT9B estimations presented RMS errors <3.6 degrees , r > 0.99 and 0.9 < m < 1.09. It appears therefore that (1) the protocol in combination with the MT9B is valid for, and (2) the MT9B in combination with the protocol is accurate when, measuring shoulder and elbow kinematics, during the tasks tested, in ambulatory settings.
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Articulação do Cotovelo/fisiologia , Monitorização Ambulatorial/instrumentação , Articulação do Ombro/fisiologia , Adulto , Fenômenos Biomecânicos/instrumentação , Fenômenos Biomecânicos/métodos , Humanos , Magnetismo , Masculino , Modelos Anatômicos , Monitorização Ambulatorial/métodos , Amplitude de Movimento ArticularRESUMO
In the above paper, by Imbinto et al. (IEEE Rev. Biomed. Eng., vol. 9, pp. 32-48, 2016), typographical errors appear in (1) (2) (3), whereas (4) is missing of a factor; all the equations are reported within Section III-C of the paper. The modifications are provided in this paper.
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BACKGROUND: Return to work represents an important milestone for workers who were injured during a workplace accident, especially if the injury results in needing a wheelchair for locomotion. OBJECTIVE: The aim of the study was to design a framework for training novice wheelchair users in regaining autonomy in activities of daily living and in the workplace and for providing medical personnel with objective data on users' health and work-related capabilities. METHODS: The framework design was accomplished following the "Usability Engineering Life Cycle" model. According to it, three subsequent steps defined as "Know your User", "Competitive Analysis" and "Participatory Design" have been carried out to devise the described framework. RESULTS: The needs of the end-users of the framework were identified during the first phase; the Competitive Analysis phase addressed standard care solutions, Virtual Reality-based wheelchair simulators, the current methodologies for the assessment of the health condition of people with disability and the use of semantic technologies in human resources. The Participatory Design phase led to the definition of an integrated user-centred framework supporting the return to work of wheelchair users. CONCLUSION: The results of this work consists in the design of an innovative training process based on virtual reality scenarios and supported by semantic web technologies. In the near future, the design process will proceed in collaboration with the Italian National Institute for Insurance against Accidents at Work (INAIL). The whole framework will be then implemented to support the current vocational rehabilitation process within INAIL premises.
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Pessoas com Deficiência/reabilitação , Reabilitação Vocacional/métodos , Retorno ao Trabalho , Cadeiras de Rodas , Atividades Cotidianas , Desenho de Equipamento , Humanos , Web Semântica , Realidade Virtual , Local de TrabalhoRESUMO
People with a high level of disability experience great difficulties to perform activities of daily living and resort to their residual motor functions in order to operate assistive devices. The commercially available interfaces used to control assistive manipulators are typically based on joysticks and can be used only by subjects with upper-limb residual mobilities. Many other solutions can be found in the literature, based on the use of multiple sensory systems for detecting the human motion intention and state. Some of them require a high cognitive workload for the user. Some others are more intuitive and easy to use but have not been widely investigated in terms of usability and user acceptance. The objective of this work is to propose an intuitive and robust user interface for assistive robots, not obtrusive for the user and easily adaptable for subjects with different levels of disability. The proposed user interface is based on the combination of M-IMU and EMG for the continuous control of an arm-hand robotic system by means of M-IMUs. The system has been experimentally validated and compared to a standard voice interface. Sixteen healthy subjects volunteered to participate in the study: 8 subjects used the combined M-IMU/EMG robot control, and 8 subjects used the voice control. The arm-hand robotic system made of the KUKA LWR 4+ and the IH2 Azzurra hand was controlled to accomplish the daily living task of drinking. Performance indices and evaluation scales were adopted to assess performance of the two interfaces.
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Pessoas com Deficiência/reabilitação , Eletromiografia/instrumentação , Reabilitação , Robótica/instrumentação , Tecnologia Assistiva , Acelerometria/instrumentação , Adulto , Desenho de Equipamento , Humanos , Reabilitação/instrumentação , Reabilitação/métodos , Adulto JovemRESUMO
The loss of one hand can significantly affect the level of autonomy and the capability of performing daily living, working and social activities. The current prosthetic solutions contribute in a poor way to overcome these problems due to limitations in the interfaces adopted for controlling the prosthesis and to the lack of force or tactile feedback, thus limiting hand grasp capabilities. This paper presents a literature review on needs analysis of upper limb prosthesis users, and points out the main critical aspects of the current prosthetic solutions, in terms of users satisfaction and activities of daily living they would like to perform with the prosthetic device. The ultimate goal is to provide design inputs in the prosthetic field and, contemporary, increase user satisfaction rates and reduce device abandonment. A list of requirements for upper limb prostheses is proposed, grounded on the performed analysis on user needs. It wants to (i) provide guidelines for improving the level of acceptability and usefulness of the prosthesis, by accounting for hand functional and technical aspects; (ii) propose a control architecture of PNS-based prosthetic systems able to satisfy the analyzed user wishes; (iii) provide hints for improving the quality of the methods (e.g., questionnaires) adopted for understanding the user satisfaction with their prostheses.
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The Constant-Murley score (CMS) is a popular measure of shoulder function. However, its ability to monitor the evolution of patients during rehabilitation after rotator-cuff repair is controversial. Moreover, CMS does not account for possible alterations in the scapulo-humeral coordination (SHC, scapula dyskinesis), which are apparent in variety of shoulder pathologies. To address these issues, a new formulation of CMS was firstly proposed, which rates the "affected-to-controlateral side difference in SHC" of a patient with respect to reference values of asymptomatic controls (Scapula-Weighted CMS). Then, 32 patients (53±9year-old) were evaluated with CMS and SW-CMS at 45, 70, 90-day and >6-month after rotator-cuff repair, to test three hypotheses: (1) CMS and SW-CMS are largely responsive to change; (2) accounting (SW-CMS) or not (CMS) for scapula dyskinesis leads to statistically different scores and SW-CMS cannot be predicted from CMS without clinically relevant differences; (3) 90% of patients recover a side-to-side SHC similar to asymptomatic controls at 90days. Results supported hypotheses 1 and 2. On the contrary (hypothesis 3), only 10% of patients recovered for SHC alterations at 90days, and 50% at follow-up. These findings support the use of SW-CMS and the importance of treating scapula dyskinesis after rotator-cuff repair.