Musculoskeletal complaints and disability in a group of young adults with major congenital upper limb differences in The Netherlands.

PURPOSE: To determine prevalence of musculoskeletal complaints (MSCs) in adults with major congenital upper limb differences (CoULD) compared to able-bodied controls, and to examine associations of MSCs and disability with various biopsychosocial factors. MATERIALS AND METHODS: Questionnaire-based cross-sectional study assessing MSCs, disability (using the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH)), general and mental health status, physical work demands, and upper extremity range of motion. RESULTS: Seventy-one individuals with CoULD (participation rate: 41%) and 71 controls matched on age, gender, and education were included (49% female, mean age 28.9 years). Year prevalence of MSCs was significantly higher in the CoULD group (35%) than in the control group (18%). The CoULD group was less often employed and had lower scores on all measures of upper limb range of motion and hand grip. MSCs were associated with higher DASH scores and higher reported work demands. Disability was associated with female gender, more joints with limited range of motion, unemployment, and lower general and mental health. Factors associated with disability did not differ between groups. CONCLUSIONS: MSCs are a frequent problem in young adults with major CoULD. To prevent or reduce MSC and disability, clinicians and researchers should be aware of the associated factors. Implications for rehabilitationThe year prevalence of musculoskeletal complaints (MSCs) in those with major congenital upper limb differences (CoULD) was approximately double to that of the control group, implying a potential relationship between CoULD and MSCs.Rehabilitation professionals should develop personalized strategies to manage work demands in those with CoULD, considering the association between MSCs and higher reported work demands.Recognizing the impact of a negatively perceived body image on mental health, clinicians should integrate psychological counseling into rehabilitation treatments to support mental well-being and improve overall quality of life in those with CoULD.Rehabilitation professionals should educate individuals with CoULD about the potential associations between upper limb work demands, MSCs, and disability.

The systematic and participatory development of a patient decision aid about terminal devices for people with upper limb absence: The PDA-TULA.

Selecting an upper limb prosthesis seems to be a challenge considering the high rejection rates. A patient decision aid (PDA) could support the decision-making process by providing information about available options and clarifying the patients' values related to those options. This study aims to describe the developmental process of a PDA about terminal devices (TDs) for people with upper limb absence: PDA-TULA. The developmental process was based on The International Patient Decision Aid Standards. We aimed at adults with major unilateral upper limb absence. A steering group including patients, clinicians, researchers, software and implementation experts was composed. The content and design of the PDA were based on a qualitative literature meta-synthesis, focus groups with patients and clinicians, surveys among patients and prosthetists, a nationwide digital meeting with clinicians and prosthetists, and information from manufacturers. Information on features of TDs was systematically collected, ordered, and refined. Subsequently, drafts of the PDA-TULA were made, improved, integrated into the software, and alpha tested. The digital PDA-TULA consists of three parts: (1) information about TDs; (2) consideration of personal values regarding the TDs; (3) comparison of TD profiles with a personal profile based on indicated preferences. A summarizing overview is offered to patients and clinicians. To conclude, a digital PDA, which was integrated into the national working process of clinicians, was developed in a systematic co-creation process. The PDA enables patients and their significant others to consider and formulate their preferences about TDs during the prosthesis selection process.

Perception and control of low cable operation forces in voluntary closing body-powered upper-limb prostheses.

Operating a body-powered prosthesis can be painful and tiring due to high cable operation forces, illustrating that low cable operation forces are a desirable design property for body-powered prostheses. However, lower operation forces might negatively affect controllability and force perception, which is plausible but not known. This study aims to quantify the accuracy of cable force perception and control for body-powered prostheses in a low cable operation force range by utilizing isometric and dynamic force reproduction experiments. Twenty-five subjects with trans-radial absence conducted two force reproduction tasks; first an isometric task of reproducing 10, 15, 20, 25, 30 or 40 N and second a force reproduction task of 10 and 20 N, for cable excursions of 10, 20, 40, 60 and 80 mm. Task performance was quantified by the force reproduction error and the variability in the generated force. The results of the isometric experiment demonstrated that increasing force levels enlarge the force variability, but do not influence the force reproduction error for the tested force range. The second experiment showed that increased cable excursions resulted in a decreased force reproduction error, for both tested force levels, whereas the force variability remained unchanged. In conclusion, the design recommendations for voluntary closing body-powered prostheses suggested by this study are to minimize cable operation forces: this does not affect force reproduction error but does reduce force variability. Furthermore, increased cable excursions facilitate users with additional information to meet a target force more accurately.