University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, UMCG sector F, FA 23, PO Box 196, Groningen NL-9700 AD, The Netherlands.
J Neuroeng Rehabil. 2014 Feb 25;11:16. doi: 10.1186/1743-0003-11-16.
Training increases the functional use of an upper limb prosthesis, but little is known about how people learn to use their prosthesis. The aim of this study was to describe the changes in performance with an upper limb myoelectric prosthesis during practice. The results provide a basis to develop an evidence-based training program.
Thirty-one able-bodied participants took part in an experiment as well as thirty-one age- and gender-matched controls. Participants in the experimental condition, randomly assigned to one of four groups, practiced with a myoelectric simulator for five sessions in a two-weeks period. Group 1 practiced direct grasping, Group 2 practiced indirect grasping, Group 3 practiced fixating, and Group 4 practiced a combination of all three tasks. The Southampton Hand Assessment Procedure (SHAP) was assessed in a pretest, posttest, and two retention tests. Participants in the control condition performed SHAP two times, two weeks apart with no practice in between. Compressible objects were used in the grasping tasks. Changes in end-point kinematics, joint angles, and grip force control, the latter measured by magnitude of object compression, were examined.
The experimental groups improved more on SHAP than the control group. Interestingly, the fixation group improved comparable to the other training groups on the SHAP. Improvement in global position of the prosthesis leveled off after three practice sessions, whereas learning to control grip force required more time. The indirect grasping group had the smallest object compression in the beginning and this did not change over time, whereas the direct grasping and the combination group had a decrease in compression over time. Moreover, the indirect grasping group had the smallest grasping time that did not vary over object rigidity, while for the other two groups the grasping time decreased with an increase in object rigidity.
A training program should spend more time on learning fine control aspects of the prosthetic hand during rehabilitation. Moreover, training should start with the indirect grasping task that has the best performance, which is probably due to the higher amount of useful information available from the sound hand.
训练可以提高上肢假肢的功能使用，但人们对如何学习使用假肢知之甚少。本研究旨在描述在实践过程中使用上肢肌电假肢时性能的变化。研究结果为开发基于证据的训练计划提供了基础。
31 名健康参与者参加了一项实验，以及 31 名年龄和性别匹配的对照者。实验条件下的参与者随机分为四组，在两周内进行五次肌电模拟器练习。组 1 练习直接抓握，组 2 练习间接抓握，组 3 练习固定，组 4 练习三者的组合。在预测试、后测试和两次保留测试中评估南安普顿手评估程序 (SHAP)。对照组参与者在两次测试之间没有练习的情况下，每隔两周进行两次 SHAP 测试。在抓握任务中使用了可压缩物体。研究了末端运动学、关节角度和抓握力控制的变化，后者通过物体压缩的幅度来测量。
实验组在 SHAP 上的表现比对照组有明显提高。有趣的是，固定组在 SHAP 上的表现与其他训练组相当。假肢整体位置的改善在三次练习后趋于平稳，而控制握力则需要更多的时间。开始时，间接抓握组的物体压缩最小，且随着时间的推移没有变化，而直接抓握组和组合组的压缩随着时间的推移而减少。此外，间接抓握组的抓握时间最短，且不受物体硬度的影响，而对于其他两组，抓握时间随着物体硬度的增加而减少。
康复过程中，训练计划应花费更多时间学习假肢精细控制方面。此外，训练应从间接抓握任务开始，因为该任务的表现最好，这可能是由于从健全的手获得的有用信息量较高。
