Vujaklija Ivan, Jung Moon Ki, Hasenoehrl Timothy, Roche Aidan D, Sturma Agnes, Muceli Silvia, Crevenna Richard, Aszmann Oskar C, Farina Dario
IEEE Trans Biomed Eng. 2023 Mar;70(3):789-799. doi: 10.1109/TBME.2022.3202250. Epub 2023 Feb 17.
The objective clinical evaluation of user's capabilities to handle their prosthesis is done using various tests which primarily focus on the task completion speed and do not explicitly account for the potential presence of compensatory motions. Given that the excessive body compensation is a common indicator of inadequate prosthesis control, tests which include subjective observations on the quality of performed motions have been introduced. However, these metrics are then influenced by the examiner's opinions, skills, and training making them harder to standardize across patient pools and compare across different prosthetic technologies. Here we aim to objectively quantify the severity of body compensations present in myoelectric prosthetic hand users and evaluate the extent to which traditional objective clinical scores are still able to capture them.
We have instructed 9 below-elbow prosthesis users and 9 able-bodied participants to complete three established objective clinical tests: Box-and-Blocks-Test, Clothespin-Relocation-Test, and Southampton-Hand-Assessment-Procedure. During all tests, upper-body kinematics has been recorded.
While the analysis showed that there are some correlations between the achieved clinical scores and the individual body segment travel distances and average speeds, there were only weak correlations between the clinical scores and the observed ranges of motion. At the same time, the compensations were observed in all prosthesis users and, for the most part, they were substantial across the tests.
The sole reliance on the currently available objective clinical assessment methods seems inadequate as the compensatory movements are prominent in prosthesis users and yet not sufficiently accounted for.
通过各种测试对用户操控假肢的能力进行客观临床评估,这些测试主要关注任务完成速度,并未明确考虑代偿动作的潜在存在。鉴于过度的身体代偿是假肢控制不足的常见指标,已引入包括对执行动作质量进行主观观察的测试。然而,这些指标随后会受到检查者的意见、技能和培训的影响,使得它们在不同患者群体中难以标准化,也难以在不同假肢技术之间进行比较。在此,我们旨在客观量化肌电假手使用者身体代偿的严重程度,并评估传统客观临床评分仍能捕捉到这些代偿的程度。
我们指导了9名肘下假肢使用者和9名健全参与者完成三项既定的客观临床测试:方块搭积木测试、晾衣夹重新定位测试和南安普敦手功能评估程序。在所有测试过程中,记录了上身的运动学数据。
虽然分析表明,获得的临床评分与身体各节段的移动距离和平均速度之间存在一些相关性,但临床评分与观察到的运动范围之间只有微弱的相关性。同时,在所有假肢使用者中都观察到了代偿情况,并且在大多数测试中,代偿情况都很明显。
仅依靠目前可用的客观临床评估方法似乎并不足够,因为代偿动作在假肢使用者中很突出,但尚未得到充分考虑。