RESUMEN
PURPOSE: To determine whether children and adults with unilateral congenital upper limb amputation can control myoelectric prostheses with multiple degrees of freedom (DOF) using pattern recognition (PR) technology. METHODS: Seven participants (age 9-62 years) with unilateral congenital transradial amputation were tested on both their residual and sound side limbs to determine proficiency in controlling a virtual prosthesis using electromyographic signals captured by an array of surface electrodes that were processed using PR technology. Proficiency was measured through a virtual environment game called the target achievement control test, in which the testing protocol asked participants to match increasingly complex prosthesis postures with 1, 2, and 3 DOF. RESULTS: All the participants successfully created a PR calibration at 1, 2, and 3 DOF with their residual limb during testing, and no differences in calibration accuracy were observed when comparing the residual versus sound upper limbs. No differences were noted in the mean completion rate on the target achievement control test between the residual and sound limbs. CONCLUSIONS: Participants with a congenital upper limb amputation achieved PR control calibration of multi-DOF prostheses with proficiency and quality results of PR calibration that were comparable to those of their sound limb. This capability was observed in children as well as in adults. This demonstrates the potential for children and adults with a unilateral congenital transradial amputation to benefit from myoelectric prostheses with PR control. CLINICAL RELEVANCE: The results from this study highlight the potential for patients in this population to benefit from myoelectric prostheses with PR control. Persons with unilateral congenital upper limb amputations can be considered for provision of this technology and enrollment in future research activities.
Asunto(s)
Amputados , Miembros Artificiales , Adolescente , Adulto , Amputación Quirúrgica , Niño , Electromiografía/métodos , Humanos , Persona de Mediana Edad , Diseño de Prótesis , Extremidad Superior/cirugía , Adulto JovenRESUMEN
Measurement is a fundamental cornerstone in all aspects of scientific discovery, including clinical research. To be useful, measurement instruments must meet several key criteria, the most important of which are satisfactory reliability, validity, and responsiveness. Part 1 of this article reviews the general concepts of measurement instruments and describes the measurement of general health, pain, and patient satisfaction.
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Brazo , Investigación Biomédica/estadística & datos numéricos , Indicadores de Salud , Dimensión del Dolor/métodos , Dimensión del Dolor/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Encuestas y Cuestionarios , Humanos , Reproducibilidad de los ResultadosRESUMEN
Part 1 of this article outlined the basic characteristics of useful clinical measurement instruments and described scales used to measure general health, pain, and patient satisfaction. Part 2 describes the features of some of the scales most commonly used in clinical research in the hand, wrist, elbow, and shoulder.
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Investigación Biomédica/estadística & datos numéricos , Codo/cirugía , Mano/cirugía , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Hombro/cirugía , Muñeca/cirugía , Actividades Cotidianas/clasificación , Evaluación de la Discapacidad , Estética , Humanos , Osteoartritis/diagnóstico , Osteoartritis/cirugía , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Wrist arthroscopy is a challenging discipline with limited training exposure during residency. The purpose of this study was to evaluate the effectiveness of virtual knee arthroscopy simulation training for gaining proficiency in wrist arthroscopy. DESIGN: Participants were recorded performing a cadaveric wrist arthroscopy simulation. The residents then practiced knee arthroscopy on a virtual reality simulator and repeated the wrist arthroscopy simulation. All videos were blinded prior to assessment. Proficiency was graded using the Arthroscopic Surgery Skill Evaluation Tool global rating scale. In addition, participants were asked to complete a survey assessing the value of the virtual reality knee arthroscopy simulator for wrist arthroscopy. SETTING: Orthopaedic Surgery Residency Program, Carolinas Medical Center, a large, public, nonprofit hospital located in Charlotte, North Carolina. PARTICIPANTS: Orthopaedic residents at our center were asked to participate in the simulation training. Participation was voluntary and nonincentivized. All orthopaedic residents at our institution (N = 27) agreed to participate. In total, there were 10 Intern (PGY-0 and PGY-1), 10 Junior (PGY-2 and PGY-3), and 7 Senior (PGY-4 and PGY-5) residents. In addition, a fellowship-trained hand surgeon was recruited to participate in the study, performing the wrist arthoscopy simulation. Two additional fellowship-trained hand surgeons, for a total of 3, assessed the blinded videos. RESULTS: There was a trend toward better wrist Arthroscopic Surgery Skill Evaluation Tool scores by training level, although the difference was not statistically significant. Interns improved by an average of 1.8 points between baseline and postknee simulation tests. Junior and senior residents decreased by 1.6 and 5.0 points, respectively. CONCLUSIONS: Knee arthroscopy simulation training did not objectively improve wrist arthroscopy proficiency among residents. A wrist-specific arthroscopy simulation program is needed if measurable competence through simulation is desired.
Asunto(s)
Artroscopía/educación , Competencia Clínica , Internado y Residencia , Articulación de la Rodilla/cirugía , Procedimientos Ortopédicos/educación , Entrenamiento Simulado , Articulación de la Muñeca/cirugía , Adulto , Cadáver , Femenino , Humanos , MasculinoAsunto(s)
Ligamento Colateral Cubital/lesiones , Ligamento Colateral Cubital/cirugía , Articulación Metacarpofalángica/patología , Pulgar , Adolescente , Adulto , Anciano , Ligamento Colateral Cubital/diagnóstico por imagen , Femenino , Humanos , Masculino , Articulación Metacarpofalángica/diagnóstico por imagen , Articulación Metacarpofalángica/fisiopatología , Persona de Mediana Edad , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Soporte de Peso , Adulto JovenRESUMEN
We present a case of an immunocompromised host who developed a Candida glabrata infection 20 years after her total knee arthroplasty. She was treated with extensive irrigation and debridement, followed by placement of an amphotericin B cement spacer supplemented with 2 months of oral variconazole. She ultimately underwent an above-knee amputation.