A scoping review of digital fabrication techniques applied to prosthetics and orthotics: Part 1 of 2-Prosthetics.

BACKGROUND: Traditionally, the manufacture of prostheses is time-consuming and labor-intensive. One possible route to improving access and quality of these devices is the digitalizing of the fabrication process, which may reduce the burden of manual labor and bring the potential for automation that could help unblock access to assistive technologies globally. OBJECTIVES: To identify where there are gaps in the literature that are creating barriers to decision-making on either appropriate uptake by clinical teams or on the needed next steps in research that mean these technologies can continue on a pathway to maturity. STUDY DESIGN: Scoping literature review. METHODS: A comprehensive search was completed in the following databases: Allied and Complementary Medicine Database, MEDLINE, Embase, Global Health Archive, CINAHL Plus, Cochrane Library, Web of Science, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, and Engineering Village, resulting in 3487 articles to be screened. RESULTS: After screening, 130 lower limb prosthetic articles and 117 upper limb prosthetic articles were included in this review. Multiple limitations in the literature were identified, particularly a lack of long-term, larger-scale studies; research into the training requirements for these technologies and the necessary rectification processes; and a high range of variance of production workflows and materials which makes drawing conclusions difficult. CONCLUSIONS: These limitations create a barrier to adequate evidence-based decision-making for clinicians, technology developers, and wider policymakers. Increased collaboration between academia, industry, and clinical teams across more of the pathway to market for new technologies could be a route to addressing these gaps.

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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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. CONCLUSION: 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.

Adjustable prosthetic sockets: a systematic review of industrial and research design characteristics and their justifications.

BACKGROUND: The prosthetic socket is a key component that influences prosthesis satisfaction, with a poorly fitting prosthetic socket linked to prosthesis abandonment and reduced community participation. This paper reviews adjustable socket designs, as they have the potential to improve prosthetic fit and comfort through accommodating residual limb volume fluctuations and alleviating undue socket pressure. METHODS: Systematic literature and patent searches were conducted across multiple databases to identify articles and patents that discussed adjustable prosthetic sockets. The patents were used to find companies, organisations, and institutions who currently sell adjustable sockets or who are developing devices. RESULTS: 50 literature articles and 63 patents were identified for inclusion, representing 35 different designs used in literature and 16 commercially available products. Adjustable sockets are becoming more prevalent with 73% of publications (literature, patents, and news) occurring within the last ten years. Two key design characteristics were identified: principle of adjustability (inflatable bladders, moveable panels, circumferential adjustment, variable length), and surface form (conformable, rigid multi-DOF, and rigid single DOF). Inflatable bladders contributed to 40% of literature used designs with only one identified commercially available design (n = 16) using this approach. Whereas circumferential adjustment designs covered 75% of identified industry designs compared to only 36% of literature devices. Clinical studies were generally small in size and only 17.6% of them assessed a commercially available socket. DISCUSSION: There are clear differences in the design focus taken by industry and researchers, with justification for choice of design and range of adjustment often being unclear. Whilst comfort is often reported as improved with an adjustable socket, the rationale behind this is not often discussed, and small study sizes reduce the outcome viability. Many adjustable sockets lack appropriate safety features to limit over or under tightening, which may present a risk of tissue damage or provide inadequate coupling, affecting function and satisfaction. Furthermore, the relationship between design and comfort or function are rarely investigated and remain a significant gap in the literature. Finally, this review highlights the need for improved collaboration between academia and industry, with a strong disconnect observed between commercial devices and published research studies.

Evaluation of a novel biomechanics-informed walking frame, developed through a Knowledge Transfer Partnership between biomechanists and design engineers.

BACKGROUND: Walking aids such as walking frames offer support during walking, yet paradoxically, people who self-report using them remain more likely to fall than people who do not. Lifting of walking frames when crossing door thresholds or when turning has shown to reduce stability, and certain design features drive the need to lift (e.g. small, non-swivelling wheels at the front). To overcome shortfalls in design and provide better stability, biomechanists and industrial engineers engaged in a Knowledge Transfer Partnership to develop a novel walking frame that reduces the need for lifting during everyday tasks. This paper presents the results for the final prototype regarding stability, safety and other aspects of usability. METHODS: Four studies were conducted that explored the prototype in relation to the current standard frame: a detailed gait lab study of 9 healthy older adults performing repeated trials for a range of everyday tasks provided mechanical measures of stability, a real-world study that involved 9 users of walking frames provided measures of body weight transfer and lifting events, two interview studies (5 healthcare professionals and 7 users of walking frames) elicited stakeholder perceptions regarding stability, safety and usability. RESULTS: Analysis of healthy older adults using a standard walking frame and the prototype frame demonstrated that the prototype increases stability during performance of complex everyday tasks (p < 0.05). Similarly, gait assessments of walking frame users in their home environment showed that the prototype facilitated safer usage patterns and provided greater and more continuous body weight support. Interviews with healthcare professionals and users showed that the prototype was perceived to be safe and effective and hence more usable. CONCLUSIONS: The outcomes of the separate studies all support the same conclusion: the prototype is an improvement on the status quo, the typical front-wheeled Zimmer frame for indoor use which has not changed in design for decades. The significance of this work lies in the success of the Knowledge Transfer Partnership and in biomechanics-informed design leading to improvements, which in future may be applied to other walking aids, to benefit walking aid users by promoting safer, more stable use of their aid.

Repair strategies for assistive technology in low resource settings.

PURPOSE: To investigate the practices of repair that exist for users of mobility assistive products in low resource settings, as well as the psychosocial impact that the repair, or non-repair, of these devices has on users' lives. MATERIALS AND METHODS: This article collates data on repair practices and the responses from participants on the topic of repair from studies conducted by the authors across four different low resource settings in Kenya, Uganda, Sierra Leone, and Indonesia. This data was then analyzed to identify the common themes found across geographies. RESULTS: Three major models of repair practice emerged from the data: "Individual or Informal Repair in the Community"; "Local Initiatives"; and "Specialist AT Workshop Repair". Additionally, the wider impact on the participants' lives of "Problems & Concerns with Repair"; "Experiences of Breakages & Frequencies of Repair" and the "Impact of Broken Devices" are explored. CONCLUSIONS: The results of this analysis demonstrate the paramount importance of community-based repair of devices, and how despite this importance, repair is often overlooked in the planning and design of assistive products and services. There is a need to further incorporate and support these informal contributions as part of the formal provision systems of assistive device.IMPLICATIONS FOR REHABILITATIONA lack of available specialist repair services in low resource settings hinders the potential impact of assistive technology provision systems.Community-based repair is the major route by which assistive devices are repaired in low resource settings.Appropriate community-based repair strategies should be incorporated into and supported by the formal assistive technology provision models in order to optimise outcomes.A lack of data on outcomes across the lifecycle of assistive products hinders progress on improving focus on follow-up services - in particular repair & maintenance.By supporting community-based repair, repairs that are inappropriate for that approach could be better directed to specialist repair services.

Evaluation of the current status of prosthetic rehabilitation services for major limb loss: a descriptive study in Ugandan Referral hospitals.

PURPOSE: Low-and-middle-income countries (LMICs) have a large burden of major limb loss. No recent study has reported on Uganda's state of public sector prosthetics services. This study aimed to document the landscape of major limb loss, and the structure of available prosthetics services in Uganda. METHODS: This study involved a retrospective review of medical records at Mulago National Referral Hospital, Fort Portal Regional Referral Hospital, and Mbale Regional Referral Hospital, and a cross-sectional survey of personnel involved in the fabrication and fitting of prosthetic devices across orthopaedic workshops in the country. RESULTS: Upper limb amputations accounted for 14.2%, and lower limb accounted for 81.2%. Gangrene (30.3%) was the leading cause of amputation, followed by road traffic accidents and diabetes mellitus. Orthopaedic workshops offered decentralised services, and most materials used were imported. Essential equipment was largely lacking. Orthopaedic technologists had diverse experience and skill sets, but many other factors limited their service provision. CONCLUSION: The Ugandan public healthcare system lacks adequate prosthetic services both in terms of personnel and supporting resources, including equipment, materials, and components. The provision of prosthetics rehabilitation services is limited, especially in rural regions. Decentralising services could improve patients' access to prosthetic services.Implications for RehabilitationAvailability and accessibility of prosthetic services are essential to the rehabilitation and reintegration of amputees into communities in Low-and-Middle-Income countries (LMICs).For stakeholders to formulate effective plans to address issues within prosthetics service provision, quality data on the current state of services is necessary.Service providers should prioritise the decentralisation of prosthetic rehabilitation services, especially for patients in rural areas, to improve access and reach of these services.To achieve optimal limb functionality after amputation for both lower and upper limb amputees, rehabilitation professionals working in LMICs should focus on delivering comprehensive multidisciplinary rehabilitation services.Orthopaedic personnel should ensure complete and accurate documentation of patient information following amputation to enable effective tracking and monitoring of patient care to improve outcomes of rehabilitation.

The lived experience of people with upper limb absence living in Uganda: A qualitative study.

Background: The impact of upper limb absence on people's lived experiences is understudied, particularly in African countries, with implications for policy and service design. Objectives: The objective of this study was to explore the lived experiences of people with upper limb absence (PWULA) living in Uganda. Method: Informed by preliminary work, we designed a qualitative study employing semi-structured interviews to understand the experience of living with upper limb absence in Uganda. Seventeen adults with upper limb absence were individually interviewed and their interviews were analysed utilising thematic analysis. Results: Seven themes illustrating the impact on the individual's life after amputation were identified and categorised into (1) living and adapting to life, (2) productivity and participation and (3) living within the wider environment. This study presents three main findings: (1) PWULA need psychological and occupational support services which are not available in Uganda, (2) PWULA want to work, but face multiple barriers to employment and has limited support, combined with the complex parenting and caring responsibilities, (3) the local Ugandan culture and social structures affect the everyday life of PWULA, both in positive and negative ways. Conclusion: This study provides information on the lived experiences of PWULA in Uganda which are lacking in the literature. People with upper limb absence face ableism and hardship underpinned by a lack of formal support structures and policies, which may in turn exacerbate the impact of upper limb absence on multiple facets of life.

Effects of a modified passive socket system on short-term changes in residuum volume and comfort: A preliminary study in transtibial amputees.

BACKGROUND: Changes in residuum volume are a common problem in lower-limb amputees during prosthesis usage, and can lead to poor suspension, impaired gait, and tissue damage. Residuum volume can be affected by the in-socket air pressure, which will influence fluid flow in and around the residuum. The use of "active" pumps to reduce air pressure has been shown to conserve the residuum volume, but these are expensive and unlikely to be widely available. An alternative, passive approach, based on Boyles' law, is to introduce a larger distal void volume at the end of the socket and hence reduce the change in pressure for a given change in volume. OBJECTIVES: To compare the performance across three test conditions (passive-conventional, with standard distal void; passive-with increased distal void; and active system) in terms of residuum volume changes and comfort. STUDY DESIGN: Repeated-measures experiment under three test conditions. METHODS: Five transtibial amputee participants (three males and two females), aged between 27 and 67 years, and of mobility grade K2 or K3, were fitted with a bespoke test prosthesis that was adapted to include the three test conditions. Residuum volume was measured before and after walking under each test condition (presented in a random order). Comfort was also assessed after walking with each test condition. RESULTS: The reduction in residuum volume, relative to the baseline volume, was higher for the conventional passive system (4.2% ± 2.8%) compared with the modified passive (1.4% ± 1.4%) and active (1.6% ± 1.1%) systems. CONCLUSION: The use of a passive suspension system with an increased distal void within the socket may help to stabilize the residuum volume during prosthesis usage.

Co-creation and User Perspectives for Upper Limb Prosthetics.

People who either use an upper limb prosthesis and/or have used services provided by a prosthetic rehabilitation centre, experience limitations of currently available prosthetic devices. Collaboration between academia and a broad range of stakeholders, can lead to the development of solutions that address peoples' needs. By doing so, the rate of prosthetic device abandonment can decrease. Co-creation is an approach that can enable collaboration of this nature to occur throughout the research process. We present findings of a co-creation project that gained user perspectives from a user survey, and a subsequent workshop involving: people who use an upper limb prosthesis and/or have experienced care services (users), academics, industry experts, charity executives, and clinicians. The survey invited users to prioritise six themes, which academia, clinicians, and industry should focus on over the next decade. The prioritisation of the themes concluded in the following order, with the first as the most important: function, psychology, aesthetics, clinical service, collaboration, and media. Within five multi-stakeholder groups, the workshop participants discussed challenges and collaborative opportunities for each theme. Workshop groups prioritised the themes based on their discussions, to highlight opportunities for further development. Two groups chose function, one group chose clinical service, one group chose collaboration, and another group chose media. The identified opportunities are presented within the context of the prioritised themes, including the importance of transparent information flow between all stakeholders; user involvement throughout research studies; and routes to informing healthcare policy through collaboration. As the field of upper limb prosthetics moves toward in-home research, we present co-creation as an approach that can facilitate user involvement throughout the duration of such studies.

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.

Towards automation of dynamic-gaze video analysis taking functional upper-limb tasks as a case study.

BACKGROUND AND OBJECTIVE: Previous studies in motor control have yielded clear evidence that gaze behavior (where someone looks) quantifies the attention paid to perform actions. However, eliciting clinically meaningful results from the gaze data has been done manually, rendering it incredibly tedious, time-consuming, and highly subjective. This paper aims to study the feasibility of automating the coding process of the gaze data taking functional upper-limb tasks as a case study. METHODS: This is achieved by developing a new algorithm capable of coding the collected gaze data through three main stages; data preparation, data processing, and output generation. The input data in the form of a crosshair and a gaze video are converted into a 25 Hz frame rate sequence. Keyframes and non-key frames are then obtained and processed using a combination of image processing techniques and a fuzzy logic controller. In each trial, the location and duration of gaze fixation at the areas of interest (AOIs) are obtained. Once the gaze data is coded, it can be presented in different forms and formats, including the stacked color bar. RESULTS: The obtained results showed that the developed coding algorithm highly agrees with the manual coding method but significantly faster and less prone to unsystematic errors. Statistical analysis showed that Cohen's Kappa ranges from 0.705 to 1.0. Moreover, based on the intra-class correlation coefficient (ICC), the agreement index between computerized and manual coding methods is found to be (i) 0.908 with 95% confidence intervals (0.867, 0.937) for the anatomical hand and (ii) 0.923 with 95% confidence intervals (0.888, 0.948) for the prosthetic hand. A Bland-Altman plot also showed that all data points are closely scattered around the mean. These findings confirm the validity and effectiveness of the developed coding algorithm. CONCLUSION: The developed algorithm demonstrated that it is feasible to automate the coding of the gaze data, reduce the coding time, and improve the coding process's reliability.

A pin-array method for capturing tissue deformation under defined pressure distributions and its application to prosthetic socket design.

The Fit4Purpose project aims to develop upper limb prosthetic devices which are suitable for deployment in lower- and middle-income countries (LMIC's). Open-frame trans-radial socket designs are being considered, formed of several, linked components, including pads which interface directly with the skin surface. A mechanical tool has been developed to aid the design of pad shapes, using an array of square brass bars of varying lengths (i.e. a pin-array) to apply a chosen normal pressure distribution to an area of tissue. The shape to which the tissue is displaced can then be captured by clamping the bars together to fix their relative positions. The device is described, then three short studies are used to demonstrate its use on the forearm of a single, anatomically intact subject. The first investigates the effect of array size on the measured surface stiffness, finding an inverse relationship with a similar characteristic to previous published results. The second tests the hypothesis that a pad with a shape which duplicates that captured by the device will generate a similar overall load to the original pins if applied to the same region of tissue. The results support the hypothesis, but also highlight the sensitivity of the interface loading to the underlying muscle activation. Finally, the tool is used to demonstrate that different tissue displacements are observed when the same pressure distribution is applied to different areas of the forearm. Whilst the tool itself is a simple device, and the techniques used are not sophisticated, the studies suggest that the approach could be useful in pad design. Although it is clearly not appropriate for clinical application in its current form, there may be potential to develop the concept into a more practical device. Other applications could include the design of other devices which interface with the skin, the generation of data for validation of finite element models, including the application of known pressure distributions and tissue deformations during Magnetic Resonance Imaging, and the assessment of matrix pressure sensing devices on compliant materials with complex geometries.

An investigation of the effects of walking frame height and width on walking stability.

BACKGROUND: Walking aids are designed for structural support during walking, however, surprisingly self-reported use of a walking aid ("Yes, I use one.") has been identified as a risk factor for falling. Adjustment and design of walking aids may affect their usefulness in facilitating a stable walking pattern. We previously identified that increased body weight transfer onto a walking frame ('device loading') is associated with increased user stability. RESEARCH QUESTION: We asked: "Could adjustment of walking frame height to a lower height than clinically recommended serve as a mechanism to facilitate device loading and thereby increase stability? And: "Do ultra-narrow frames have an adverse effect on stability as compared to standard-width frames? METHODS: Ten older adults that were users of front-wheeled walking frames walked with walking frames of 1) 'standard width, standard height', 2)'standard width, low height', 3)'narrow width, standard height'. Smart Walker technology was used to record forces acting on the walking frame and inside the user's shoes, and cameras recorded relative position of the user's feet in relation to the frame's feet. Stability of the user-frame system and device loading (percent body weight transferred onto the frame) were calculated. A general linear mixed effects model was used for statistical analysis. RESULTS: A lower height setting did not increase device loading and stability, therefore adjusting the height to a lower setting proved to be an unsuccessful mechanism to increase stability. However, device loading was positively correlated with stability for all frame conditions (p < 0.05). Finally, stability was reduced when walking with the ultra-narrow, as compared to standard-width, frame (p = 0.002). SIGNIFICANCE: To increase stability in fall-prone users, active encouragement to transfer body weight onto the walking frame is needed. Considering the adverse effects of ultra-narrow frames on stability, such frames should be prescribed and used with caution.

Evaluating Reachable Workspace and User Control Over Prehensor Aperture for a Body-Powered Prosthesis.

Using a shoulder harness and control cable, a person can control the opening and closing of a body-powered prosthesis prehensor. In many setups the cable does not pass adjacent to the shoulder joint center allowing shoulder flexion on the prosthetic side to be used for prehensor control. However, this makes cable setup a difficult compromise as prosthesis control is dependent on arm posture; too short and the space within which a person can reach may be unduly restricted, too long and the user may not be able to move their shoulder sufficiently to take up the inevitable slack at some postures and hence have no control over prehensor movement. Despite the fundamental importance of reachable workspace to users, to date there have been no studies in prosthetics on this aspect. Here, a methodology is presented to quantify the reduction in the reachable volume due to the harness, and to record the range-of-motion of the prehensor at a series of locations within the reachable workspace. Ten anatomically intact participants were assessed using a body-powered prosthesis simulator. Data was collected using a 3D motion capture system and an electronic goniometer. The harnessed reachable workspace was 38-85% the size of the unharnessed volume with participants struggling to reach across the body and above the head. Across all arm postures assessed, participants were only able to achieve full prehensor range-of-motion in 9%. The methodologies presented could be used to evaluate future designs of both body-powered and myoelectric prostheses.

Technology for monitoring everyday prosthesis use: a systematic review.

BACKGROUND: Understanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring, with particular focus on low-resource settings. METHODS: A systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis users during daily-living. RESULTS: Sixty lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm. CONCLUSIONS: Activity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user's requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users.

Are older people putting themselves at risk when using their walking frames?

BACKGROUND: Walking aids are issued to older adults to prevent falls, however, paradoxically their use has been identified as a risk factor for falling. To prevent falls, walking aids must be used in a stable manner, but it remains unknown to what extent associated clinical guidance is adhered to at home, and whether following guidance facilitates a stable walking pattern. It was the aim of this study to investigate adherence to guidance on walking frame use, and to quantify user stability whilst using walking frames. Additionally, we explored the views of users and healthcare professionals on walking aid use, and regarding the instrumented walking frames ('Smart Walkers') utilized in this study. METHODS: This observational study used Smart Walkers and pressure-sensing insoles to investigate usage patterns of 17 older people in their home environment; corresponding video captured contextual information. Additionally, stability when following, or not, clinical guidance was quantified for a subset of users during walking in an Activities of Daily Living Flat and in a gait laboratory. Two focus groups (users, healthcare professionals) shared their experiences with walking aids and provided feedback on the Smart Walkers. RESULTS: Incorrect use was observed for 16% of single support periods and for 29% of dual support periods, and was associated with environmental constraints and a specific frame design feature. Incorrect use was associated with reduced stability. Participants and healthcare professionals perceived the Smart Walker technology positively. CONCLUSIONS: Clinical guidance cannot easily be adhered to and self-selected strategies reduce stability, hence are placing the user at risk. Current guidance needs to be improved to address environmental constraints whilst facilitating stable walking. The research is highly relevant considering the rising number of walking aid users, their increased falls-risk, and the costs of falls.

Upper limb activity of twenty myoelectric prosthesis users and twenty healthy anatomically intact adults.

The upper limb activity of twenty unilateral upper limb myoelectric prosthesis users and twenty anatomically intact adults were recorded over a 7-day period using two wrist worn accelerometers (Actigraph, LLC). This dataset reflects the real-world activities of the participants during their normal day-to-day routines. Participants included students, working adults, and retirees recruited from across the United Kingdom. This dataset offers a potential wealth of knowledge into a poorly understood cohort. The raw unprocessed data files and the activity count data exported from the Actilife software are provided. We also provide a non-wear algorithm developed for the removal of prosthesis non-wear periods and resulting activity count data corresponding to prothesis wear periods. Finally, we have included the transposed activity diaries provided by the participants. Analysis to date has primarily involved assessment of the symmetry of upper limb activity, however, there is potential to undertake additional analysis such as understanding the differences in the way a prosthesis is used compared to an anatomical arm.

Upper- and lower-limb amputees show reduced levels of eeriness for images of prosthetic hands.

The "uncanny phenomenon" describes the feeling of unease associated with seeing an image that is close to appearing human. Prosthetic hands in particular are well known to induce this effect. Little is known, however, about this phenomenon from the viewpoint of prosthesis users. We studied perceptions of eeriness and human-likeness for images of different types of mechanical, cosmetic, and anatomic hands in upper-limb prosthesis users (n=9), lower-limb prosthesis users (n=10), prosthetists (n=16), control participants with no prosthetic training (n=20), and control participants who were trained to use a myoelectric prosthetic hand simulator (n=23). Both the upper- and lower-limb prosthesis user groups showed a reduced uncanny phenomenon (i.e., significantly lower levels of eeriness) for cosmetic prosthetic hands compared to the other groups, with no concomitant reduction in how these stimuli were rated in terms of human-likeness. However, a similar effect was found neither for prosthetists with prolonged visual experience of prosthetic hands nor for the group with short-term training with the simulator. These findings in the prosthesis users therefore seem likely to be related to limb absence or prolonged experience with prostheses.

A Three-Site Clinical Feasibility Study of a Flexible Functional Electrical Stimulation System to Support Functional Task Practice for Upper Limb Recovery in People With Stroke.

Introduction: Of those people who survive a stroke, only between 40 and 70% regain upper limb dexterity. A number of reviews have suggested that functional electrical stimulation (FES) may have a beneficial effect on upper limb motor recovery. In light of the promise offered by FES and the limitations with current systems a new system was developed (FES-UPP) to support people with stroke (PwS) to practice a range of voluntary controlled, FES-assisted functional activities. Objective: This paper reports on a three center clinical investigation with the primary aim of demonstrating compliance of the new FES system with relevant essential requirements of the EU Medical Device Directive, namely to evaluate whether use of the FES-UPP enables PwS to perform a wider range of functional activities, and/or perform the same activities in an improved way. Design: Clinical investigation and feasibility study. Settings: An in-patient stroke unit, a combined Early Supported Discharge (ESD) and community service, and an outpatient clinic and in-patient stroke unit. Participants: Nine therapists and 22 PwS with an impaired upper limb. Intervention: Every PwS was offered up to eight sessions of FES-UPP therapy, each lasting ~1 h, over a period of up to 6 weeks. Primary and secondary outcome measures: The operation, acceptability, and feasibility of the interventions were assessed using video rating and the Wolf Motor Function Test Functional Ability Scale (WMF-FAS), direct observations of sessions and questionnaires for therapists and PwS. Results: The system enabled 24% (Rater A) and 28% (Rater B) of PwS to carry out a wider range of functional tasks and improved the way in which the tasks were performed (mean scores of 2.6 and 2.2 (with FES) vs. mean scores 1.5 and 1.3 (without FES) (p < 0.05). Conclusion: The FES-UP proved feasible to use in three different clinical environments, with PwS who varied widely in their impairment levels and time since stroke. Therapists and therapy assistants from a wide range of backgrounds, with varying degrees of computer and/or FES knowledge, were able to use the system without on-site technical support.

Objective measures of rollator user stability and device loading during different walking scenarios.

Walking aids are widely used by older adults, however, alarmingly, their use has been linked to increased falls-risk, yet clinicians have no objective way of assessing user stability. This work aims to demonstrate the application of a novel methodology to investigate how the type of walking task, the amount of body weight supported by the device (i.e., device loading), and task performance strategy affect stability of rollator users. In this context, ten users performed six walking tasks with an instrumented rollator. The combined stability margin "SM" was calculated, which considers user and rollator as a combined system. A Friedman Test was used to investigate the effects of task on SM and a least-squares regression model was applied to investigate the relationship between device loading and SM. In addition, the effects of task performance strategy on SM were explored. As a result, it was found that: the minimum SM for straight line walking was higher than for more complex tasks (p<0.05); an increase in device loading was associated with an increase in SM (p<0.05); stepping up a kerb with at least 1 rollator wheel in ground contact at all times resulted in higher SM than lifting all four wheels simultaneously. Hence, we conclude that training should not be limited to straight line walking but should include various everyday tasks. Within person, SM informs on which tasks need practicing, and which strategy facilitates stability, thereby enabling person-specific guidance/training. The relevance of this work lies in an increase in walking aid users, and the costs arising from fall-related injuries.