The Compendium - ISPO UK MS · By way of background, t he Trent Prosthetics Symposium (TPS) was the vision of three clinicians from the Nottingham area: Vivian Ibbotson, Janet Kingston

28th September – 1st October 2016 Glasgow, UK

“Advances in our Understanding”

The Compendium

International Society for Prosthetics and Orthotics United Kingdom Member Society

Trent International Prosthetic Symposium

2016

ISPO UK MS

Annual Scientific Meeting

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CONTENTS

Welcome…………………………………………………………………1

ProgrammeWednesday28September.……………………………………………………….3Thursday29September.…………………………………………………………..5Friday30September………………………………………………………………….7Saturday1October…………………………………………………………………..9

PosterExhibition…………………………………………………..11

GuestSpeakers………………………………………………………12

AbstractsWednesday28September……………………………………………………….14Thursday29September……………………………………………………………37Friday30September………………………………………………………………..66Saturday1October–ProstheticsStream…………………………………84Saturday1October–OrthoticsStream…………………………………….94

Sponsors&Exhibitors……………………………………………98

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WELCOME

We are delighted to welcome you to the first joint Trent International ProstheticsSymposiumandISPOUKMSAnnualScientificMeeting(TIPS/ISPO2016).

By way of background, the Trent Prosthetics Symposium (TPS) was the vision of threecliniciansfromtheNottinghamarea:VivianIbbotson,JanetKingstonandJohnRonald.TPSfocussed exclusively on Upper Limb Prosthetics and was also unashamedly clinical in itsoutlook, with a balance of research and clinical papers. It was held over three days andenjoyedareputationforitslivelysocialprogramme.Whenthethreecolleaguesretired,theISPO UK Member Society took responsibility for its continuance, and developed the eventintoaninternationalconference:TIPS.ThisisthefirstyearwehavechosentocombineourlocalscientificmeetingwithTIPS,atthesamevenue.

ThethemeofTIPS/ISPO2016is:AdvancesinourUnderstanding.Withadvancesincompactcomputersandmedicalsciences,itisnowbecomingpossibletounlockhowwecontrolourlimbandhowpeopleadapttolimbdeficiency. Wecanusethisknowledgetoimprovethecontrolandcomfortoftheprostheticlimb.Weaimtocreateaforumtoallowcolleaguestopresentthistoyou,theaudience.

Deliveringa scientificprogrammeof thehighestquality isa longstanding traditionatbothTIPS and ISPO. We can achieve this thanks to the many nationally and internationallyrenownedguestspeakers,frombothtechnical,clinicalandscientificbackgrounds,whoarewillingtocontribute.

Our multidisciplinary approach to amputee rehabilitation includes participation fromEngineers, Physicians, Surgeons, Occupational Therapists, Physiotherapists, Prosthetists,Orthotists, Clinical Scientists and many other professions, and this is well reflected in theprogramme.

Keynote speakers at TIPS this year are Tamar Makin, from Oxford University, challengingcurrentthinkingonthelinkbetweenphantompainandbrainplasticity;RickardBranemarkfromIntegrumSwedenonthelatestdevelopmentsinOsseointegration,andRaoulBongers(The Netherlands) and Carol Garcia (Sheffield Hallam University, UK) who will discuss theapplicationsofVirtualRealityinprostheticrehabilitation.Theresponsetothecallforfreepaperabstractswasphenomenalresultinginaprogrammeof over 50 free paper presentations from speakers across the globe - from the USA toAustralia; Holland to Japan. There is an interest in functional assessment and outcomemeasures,withanumberofpresentationsonthedevelopmentofnewmeasurementtoolsaswellastheiruseingaugingtheimpactofnewprostheticdesignorhowpeopleadaptandlearntousetheirprostheses.Alongside the techniques and technology, case study presentations will cover differentaspectsoftheprocess.Oneofthenewfactorscurrentlyimpactingourfieldis3DPrinting,(also known as Rapid Manufacturing). Using this technique we can now produce itemscompletelycustomisedtotheindividual.Thequestionsweallaskconcernhoweffectiveorusefulthesesolutionsare?Howlongwilltheylast?Paperswillbepresentedwhichaimtoanswertheseconcerns.

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TheGeorgeMurdochPrizeMedalwillbeawardedattheISPOUKAnnualScientificMeetingand we congratulate Dr David Moser for his winning paper and for his outstandingcontributiontoamputeerehabilitation.TheprestigiousBlatchfordLecturewillbepresentedby Levi J Hargrove from the the Rehabilitation Institute of Chicago on work involvingTargetedMuscleReinnervation.

NeitherTIPSnor theannual ISPOUKmeetingcould takeplacewithout thestrongsupportand sponsorship of the commercial companies. Special thanks are extended to Platinumsponsors,TouchBionics,GoldsponsorsSteeperandOpcare,SilverSponsors,OttobockandFillauer, Bronze Sponsors,Coapt; and to Blatchfords,OETT andNorth Sea Plastics fortheir generous contributions. In tandem, and with the support of all our commercialexhibitors,thisenablestheorganisingcommitteetohostafirstclassscientificmeetingandcommercial exhibition, along with a lively, entertaining social programme. Please ensureyoutaketimetovisitthecommercialexhibitionstandsandengagewiththeexhibitors.Theircontributiontotheeventisinvaluable.

Glasgowisavibrantcity,richinhistoricaltraditions. It isaplacewherethereisenormousheritage, spectacular architecture, many museums, world class restaurants, art galleries,theatresandmusic venues. Its logoandbranding“PeoplemakeGlasgow” iswell reveredthroughout the world, and as such, we feel it’s the perfect backdrop for TIPS/ISPO2016.Afterall,it’syou,ourdelegatesandpresenters-“people”-whowillmakeTIPS/ISPO2016aresoundingsuccessbyembracingtheopportunitytoinformandbeinformed,engageandbeengaging, inspireandbe inspired. Wehopeyourexperience ismemorable. Welcome toGlasgow!

DrTLalLandhamChairmanISPOUKMS

DavidGowChairmanTIPS2016

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PROGRAMMEWednesday28September2016TIPS2016AUDITORIUM 0730hrs0815hrs

RegistrationOpensWelcome–DavidGow

0830hrs

Chair:CorryvanderSluisEffectsofaddingvibrotactilefeedbacktoamyoelectriccontrolledhandonperformanceandvisualattentionwithadisruptionofvisualfeedback

EitanRaveh,Dept.ofOccupationalTherapy,TevAvivUniversity,Israel0845hrs Myoelectricprosthesisfollowingtotalthumbamputation VGvanHeijningen,RijndamRehabilitationInstitute,ErasmusMedicalCenter,Rotterdam,TheNetherlands0900hrs ImpactofBilateralUpperLimbProsthesisSimulatorsinPre-ProstheticTraining:aCaseStudy DebraLatour,TRSProsthetics,Boulder,CO,USA0915hrs Theuseof3DCADCAMsysteminthedesignandmanufactureofforequarterprosthesis MCurrie&LPowell,ARClinic9,AddenbrookesHospital,Cambridge,UK0930hrs TheimpactofPartialHandAmputation-aCasePresentation LindseyBarker,HaroldWoodLongTermConditionsCentre,Essex,UK0940hrs MyoelectricarmprosthesisapproachinchildrenattheJapanHyogoRehabilitationCenter YaekoShibata,HyogoRehabilitationCenter,Kobe,Japan 1000hrs Refreshments/ExhibitorShowcase

1030hrs

Chair:PeterKyberdLatestdevelopmentsintheuseofOsseointegratedupperlimbprosthesesRickardBranemark,DirectorofCentreofOrthopaedicOsseointegration,SahlgrenskaUniversityHospital,Gothenburg,Sweden

1130hrs PPP-Arm:theimplementationofanationalProsthesisPrescriptionProtocol PAWijdenes,Dept.ofRehabilitationMedicine,UniversityMedicalCenter,Groningen,TheNetherlands1145hrs

Forminganinternationalconsortiumforsharingresourcesofupperlimbabsenceworldwide-thehandsmartgroup

LiselotteNHermansson,Dept.ofProsthetics&Orthotics,ÖrebroUniversityHospital,Örebro,Sweden 1200hrs Lunch/ExhibitorShowcase

1300hrsChair:ClaudioCastelliniDevelopingatesttodeterminequalityofproportionalcontroloveramyoelectricprosthetichand

AnniekHeerschop,CentreforHumanMovementSciences,UniversityofGroningen,TheNetherlands1315hrs EvolutionofRefinedClothespinRelocationTestforProsthesisUsersforuseasaClinicalAssessment AliHussaini,InstituteofBiomedicalEngineering,UniversityofNewBrunswick,Canada1330hrs

AnExplorationofthecorrelationbetweenanamendedBoxandBlocksAssessment,thestandardBoxandBlocksAssessmentandtheAssessmentofCapacityofMyoelectricControl,withmyoelectricprosthesisusers

MelissaJacobs,QueenMary'sHospital,London,UK1340hrs

Developmentandreliabilitytestingofaqualitativescoreforratingcompensatorymovementsinupperlimbprosthesiswearersduringexecutionof4FCE-tests

TMJvanderLaan,UniversityMedicalCentreGroningen,TheNetherlands1350hrs

Developmentofafunctionalcapacityevaluationmeasurementforindividualswithupperlimbreductiondeficiencyoramputation

CKvanderSluis,UniversityMedicalCentreGroningen,TheNetherlands

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1405hrs

Areflectivecasestudyofaquadrilateralamputee,overa16yearperiod:exploringcopingwiththechallengesofactivitiesofdailyliving,prostheticinterventionsandadjustingtothepsychologicalimpactofsuchasevereleveloflimbloss

CharlieHurd,WestMidlandsRehabilitationCentre,Birmingham,UK1420hrs

Aprotocoltoestablishtherelativeimportanceoffactorsinfluencingeaseofmyoelectricprosthesiscontrol

AlixChadwell,UniversityofSalford,Salford,UK1435hrs Choosingamulti-functionalhandthatsuitsthepatient'srequirements JudyDavidson,EasternSydneyOccupationalTherapy,Sydney,Australia 1445hrs POSTERPRESENTATIONS 1500hrs Refreshments/PosterExhibition/ExhibitorShowcase

1530hrsChair:RaoulBongers3Dprintedupperlimbprostheticsarenotbackedbyclinicalevidence

LauraEDiment,InstituteofBiomedicalEngineering,UniversityofOxford,UK1545hrs Utilising3Dprintingtechniqueswhenprovidinguniqueassistivedevices:aCaseStudy SarahDay,NationalCentreforProsthetics&Orthotics,UniversityofStrathclyde,Glasgow,UK1600hrs ApplicationofFinch,a3Dprintedprosthetichand,toapatientwithbilateralupper-limbdeficiency SatokoNoguchi,TheUniversityofTokyoHospital,Tokyo,Japan 1610hrs MANUFACTURERS'WORKSHOPS TouchBionics;Steeper;Ottobock;TRS/Fillauer 1740hrs DAYEND 1900hrs WelcomeReception&Buffet

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Thursday29September2016TIPS2016AUDITORIUM 0800hrs

RegistrationOpens

Chair:MaxOrtiz0830hrs Advancesinprosthesiscontrol-gesturecontrol AlisonGoodwin,TouchBionics,Livingston,UK0845hrs Structuredtrainingforadvancedprosthesiscontrol SebastianAmsuss,OttobockHealthcareProductsGmbH,Vienna,Austria0900hrs Upperlimbosseointegration,prosthetictechnology SteweJὅnsson,TeamOlmed,Kungsbacka,Sweden0915hrs ClinicalPatternRecognitionintheUS:ExperiencesandDemographics BlairALock,CoaptLLC,Chicago,IL,USA0930hrs Clinicalexperienceofdevelopingbespokecyclingprostheses BrianBradbury&PaulRichardson,PACERehabilitation,Cheadle,UK0945hrs EvolutionofanAestheticHeavy-DutyElectricTerminalDevice HaroldHSears,MotionControldiv.ofFillauer,Utah,USA 1000hrs Refreshments/ExhibitorShowcase

1030hrs

Chair:LiselotteHermanssonPhantomPainRevisitedTamarMakin,AssociateProfessor,FMRIBCentre,NuffieldDepartmentofClinicalNeuroscience,UniversityofOxford,UK

1130hrs Investigationsoftheuncannyvalleyforprosthetichands EllenPoliakoff,UniversityofManchester,Manchester,UK1145hrs Exploringeverydaymaterialsandprosthetichands GrahamPullin,DJCAD,UniversityofDundee,Dundee,UK 1200hrs Lunch/ExhibitorShowcase

1300hrsChair:EllenPoliakoffCASESTUDIES

1400hrs

Chair:MelissaJacobsOsseointegratedProsthesesforTranshumeralAmputees:Long-termfollowupofpatientsusingPatient-ratedOutcomeMeasures

KerstinCaine-Winterberger,SahlgrenskaUniversityHospital,Gothenburg,Sweden1415hrs Decreasingphantomlimbpainbyvirtualreality-aCasePresentation ZPihlar,UniversityRehabilitationInstitute,Ljubljana,Slovenia1430hrs CutaneousAnchorTechnologyandCreativeSolutionstoComplexProblems DebraLatour,Single-HandedSolutionsLLC,Springfield,MA,USA 1445hrs POSTERPRESENTATIONS 1500hrs Refreshments/PosterExhibition/ExhibitorShowcase

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1530hrs

Chair:TamarMakinFactorsinfluencinguseandsatisfactionwithupperlimbprosthesis

HBurger,UniversityRehabilitationInstitute,Ljubljana,Slovenia1545hrs

Theinfluenceofenvironment:experiencesofusersofmyoelectricarmprosthesis:aQualitativeStudyCathrineWidehammar,Dept.ofPediatrics,ÖrebroUniversityHospital,Örebro,Sweden

1600hrs Therelationshipbetweenprostheticcontrol,wearingpatternsanddailyprosthesisuse LiselotteNHermansson,Dept.ofProsthetics&Orthotics,ÖrebroUniversity,Örebro,Sweden1615hrs

Symptomseverityandprosthesisuse:exploringthepainexperienceusingtheDisabilitiesoftheArmShoulderandHand(DASH)

LewisMackay,TouchBionics,Livingston,UK1630hrs

Useofmyoelectricprosthesesandparticipationineverydayactivities-environmentalfactorsimpactonassistivetechnologyuseCathrineWidehammar,Dept.ofPediatrics,Örebro,UniversityHospital,Örebro,Sweden

1645hrs

Web-basedinnovativecareusingGemstrackerAADA,introducingremotefollowup(monitoring)offunctionLMMelis-Schrijver,RijndamRehabilitationInstitute,ErasmusMedicalCenter,Rotterdam,TheNetherlands

1700hrs

ComparisonofprostheticterminaldevicegripforceadjustabilitybetweenmyoelectriccontrolandBowdencablecontrol

KengoOhnishi,TokyoDenkiUniversity,Tokyo,Japan1715hrs

ScottishSpecialistProstheticsService:Advancesinourunderstandingwithfitting,training,providingandmaintainingmulti-articulatingupperlimbprostheticsforourpatients

BrianGarrett&AnneSillitoe,SMARTCentre,Edinburgh,UK1725hrs

ReportofsurveyonsituationandtheuseofunilateralTRmyoelectrichandinJapan:Comparisonbetweencontinuoususerandsuspendedtousegroups

JumpeiOba,Dept.ofOccupationalTherapy,KobeGakuinUniversity,Kobe,Japan 1735hrs DAYEND 1900hrs TIPSDINNER

1405hrs







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Friday30September2016TIPS/ISPO2016ARCOONASUITE 0800hrs Registrationopens

Chair:LaurenceKenny

0830hrs TextileElectrodesforAcquisitionofMyoelectricSignals ShannonBrown,ChalmersUniversityofTechnology,Goteborg,Sweden0845hrs DigitalControllerforArtificialLimbsfedbyNeuromuscularInterfacesviaOsseointegration EnzoMastinu,ChalmersUniversityofTechnology,Goteborg,Sweden0900hrs ImpactofUpperLimbVC-VOProsthesisSimulatorsinProstheticRehabilitation DebraLatour,TRSProsthetics,Boulder,CO,USA0915hrs

Apreliminarystudyoncharacterisationoffingerinterfacekineticsusingapressureandshearsensorsystem

NicholasHale,UniversityofSouthampton,Southampton,UK0930hrs

ValidationofAnyBody™modelkinematicsforcharacterisingprosthesisfunctionalusage:acomparisonwithVicon®Plug-in-Gaitmodel

VikranthHNagaraja,InstituteofBiomedicalEngineering,UniversityofOxford,UK 0945hrs Refreshments/ExhibitorShowcase

1030hrs

Chair:SarahDaySeriousGaminginlearningtouseaprostheticdeviceRaoulBongers,AssistantProfessor,CentreforHumanMovementSciences,UniversityMedicalCentre,Groningen,TheNetherlands

1115hrs

Patient’sperceptionsofupperlimbprostheticsandhowvirtualrealitymaybeusedinclinicalpracticeCarolGarcia,SeniorPhysiotherapyLecturerandTeamLeaderPhysiotherapist,FacultyofHealth&Wellbeing,SheffieldHallamUniversity,Sheffield,UKTopreviewworkvisithttps://m.youtube.com/watch?v=Hp_KKhPMXJEonChannel4news270716

1200hrs Lunch/ExhibitorShowcase

1300hrs

Chair:KainoushNazarpourSimulatedgrippingofanobjectwithareal-timemusculoskeletalmodelofthehand:applicationtoprosthesiscontrol

Author:EdwardKChadwick,GuyHiltonResearchCentre,KeeleUniversity,Stoke-on-Trent,UKPresenter:AmartyaGanguly,ISTM–KeeleUniversity,Stoke-on-Trent,UK

1315hrs

Amultimodalimmersivehapticvirtualrealitysystemfortherehabilitationofphantomlimbpaininupperlimbamputees

PeterSnow,RoyalNationalOrthopaedicHospital,Stanmore,UKTopreviewworkvisithttps://m.youtube.com/watch?v=Hp_KKhPMXJEonChannel4news270716

1330hrs

Chair:PeterKyberd/SaeedZahediMANUFACTURERS'PANELDISCUSSIONBlairLock,CoaptHaroldSears,MotionControlMartinSchoppl,OttobockTedVarley,SteeperBobRadocy,TRSBillHanson,LTi

1500hrs CLOSE-TIPS2016

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1500hrs

Refreshments/ExhibitorShowcase

1530hrs

Chair:LalLandhamAssessingVariabilityinLowerLimbProstheticSocketFabricationASDickinson,FacultyofEngineeringandtheEnvironment,UniversityofSouthampton,UK

1542hrs

Comparisonofsubjectsusingpurelymechanicalhipdisarticulation/hemipelvectomylimbstothoseusinghydraulicandmicroprocessorlimbsElenaHarris,WESTMARC,QueenElizabethUniversityHospital,Glasgow,UK

1554hrs

Gon(y)algiaparasthetica/Saphenousneuralgia:masqueradingasresiduallimbpainABoppana,WestMidlandsRehabilitationCentre,Birmingham,UK

1606hrs

CharacterisationofLowCostCAD/CAMScannersASDickinson,FacultyofEngineering&theEnvironment,UniversityofSouthampton,UK

1618hrs

PatternsofbonydeformityfollowingtranstibialamputationduetosepticaemiaMGeada,RoyalNationalOrthopaedicHospital,Stanmore,UK

1630hrs

EquippingTherapiststorehabilitateamputeespostsuddenonsetnaturaldisaster–BACPAR’sCollaborationwithHandicapInternationalUKMJCole,SchoolofRehabilitationSciences,StGeorge’s,UniversityofLondon,London,UK

1642hrs

GeorgeMurdochPrizeLecture-IntroducedbyProfessorRajivHanspal,President,ISPOThedevelopmentofbiomimetichydraulicself-aligninganklesforlowerlimbamputeesDrDavidMoser,HeadofResearch,BlatchfordGroup,Basingstoke,UK

1715hrs ISPOUKMSANNUALGENERALMEETING 1745hrs DAYEND 1900hrs

ISPODINNER

1405hrs







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Saturday1October2016ISPO2016-PROSTHETICSSTREAMARCOONASUITE0800hrs Registrationopens

Chair:SaeedZahedi

0830hrs

TargetedMuscleReinnervation:UKexperiencesInvitedSpeaker:NorbertKang,ConsultantPlasticSurgeon,RoyalFreeHospital,London,UK

0900hrs OutcomesandChallengesoffittingmicroprocessorcontrolledknees:a6-monthreview LauraBrady,WestMARC,QueenElizabethUniversityHospital,Glasgow,UK0912hrs Clinicalevaluationofameasurementsystemforloadingatthelowerlimbstump/socket interface MichaelMcGrath,FacultyofEngineeringandtheEnvironment,UniversityofSouthampton,UK0924hrs The3-layersiliconesocketdesignforlowerlimbamputees IanTalbot&LynzyHolding,AintreeUniversityHospital,Liverpool,UK0936hrs Towardsacomputationallyefficientmodeloftranstibialsocketfitting JWSteer,FacultyofEngineeringandtheEnvironment,UniversityofSouthampton,UK0948hrs Assessmentofsocketinterfacekinematicsandkineticsbasedonatrans-femoralamputee casestudy JinghuaTang,FacultyofEngineeringandtheEnvironment,UniversityofSouthampton,UK 1000hrs Refreshments/ExhibitorShowcase

1045hrs

Chair:PeterKyberdTheBlatchfordLecture:TargetedMuscleReinnervationGuestSpeaker:LeviJHargrove,AssociateProfessorofPhysicalMedicine&Rehabilitation,NorthwesternUniversity,Chicago,IL,USA

1200hrs Lunch/ExhibitorShowcase 1300hrs Thefuturefundingofadvancedprostheses

ImadSedki,TheRoyalNationalOrthopaedicHospital,Stanmore,UKJohnColvin,WestMARC,NHSGreaterGlasgow&Clyde,Glasgow,UK

AlanMistlin,FrimleyParkHospitalNHSFoundationTrust,UKMinistryofDefence,UK

1330hrs

DirectSkeletalFixation:AnOverviewSSooriakumaran,QueenMary’sHospital,Roehampton,London,UK

1400hrs

PanelDiscussion:InterfaceTechnologyImadSedki,TheRoyalNationalOrthopaedicHospital,Stanmore,UKJohnColvin.WestMARC,NHSGreaterGlasgow&Clyde,Glasgow,UKCarolynYoung,ProgrammeofCareLead–Trauma,NHSEngland(Midlands&East),UK

1445hrs

Prizegiving

1515hrs CONFERENCECLOSE

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Saturday1October2016ISPO2016-ORTHOTICSSTREAMCLYDESUITE0800hrs0915hrs

RegistrationopensChair:SteveSeccombeTheOETTLECTUREOrthoticsinaDigitalWorld

GuestSpeaker:ChrisDrake,OrthoticsExpertsLtd.,London,UK 1030hrs Effectivenessandcosteffectivenessofprostheticsandorthoticsservices/interventions

AHealy,ScienceCentre,StaffordshireUniversity,Stoke-onTrent,UK

1045hrs UseoftheTheoryofPlannedBehaviourtounderstandbeliefsaboutuseofAnkle-FootOrthoses (AFOs)inpeoplewithstroke ChristineMcMonagle,NCPO,DeptofBiomedicalEngineering,UniversityofStrathclyde,Glasgow,UK1100hrs

ExtendingPractice:TheroleofanOrthotistwithintheOrthopaedicClinicLauraBarr,ExtendedScopeOrthotist(Foot&AnkleOrthopaedics)GreaterGlasgow&ClydeNHS,Glasgow,UK

1130hrs

Lowerlimbsalvagea“doubleedgesword”FrankLBowlingMSc(Surg)DPMPhD,FFPM,RCPSPodiatricDoctor(Surgery),UniversityofManchester,Manchester,UK

1200hrs Lunch/ExhibitorShowcase 1300hrs

Partialfootamputation:orthoticorprostheticcarepathway–whichisbetter?LindseyWebster,Orthotist,QueenMary’sHospital,Roehampton,London,UK

1330hrs

TheuseofCAD/CAMTechnologyinClinicFrancescaMakey&NigelBirkett,SheffieldMobility&SpecialistRehabilitationCentre,Sheffield,UK

1445hrs Prizegiving 1500hrs CONFERENCECLOSE

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POSTEREXHIBITIONAContentAnalysisoffactorsassociatedwithembodimentofupperlimbprosthesesAndrewDHodrien,UniversityofSalford,Salford,UKOrthoticequipmentincomprehensivehabilitationofchildwithbilateralcongenitaldeficiencyofupperlimbs–casereportDarinkaBrezovar,UniversityRehabilitationInstitute,Ljubljana,SloveniaPatientwithbilateraltrans-humeralamputation:whattosuggest?(Acasestudy)MatejBurgar,UniversityRehabilitationInstitute,Ljubljana,SloveniaACoordinationDynamicsApproachtoTestMulti-DOFMyoelectricProstheses:PreliminaryResultsAndreasFranzke,UniversityofGroningen,TheNetherlandsHighdefinitionsiliconesuctionsocketMikePickering,SpecialisedAbilityCentre,Manchester,UKAholisticandreflectivecasestudyofaquadrilateralamputeeovera16yearperiodCharlieHurd,WestMidlandsRehabilitationCentre,Birmingham,UKPre-ClinicalApplicationofAbstractMuscleSynergiesforMyoelectricControlMatthewDyson,UniversityofNewcastle,UKAbriefanalysisofaprosthetichandperformanceevaluationtoolintermsofahumaninterfacetheoryIsamuKajitani,NationalInstituteofAdvancedIndustrialScience&Technology,Ibaraki,JapanUsertrainingforpattern-recognitionbasedmyoelectricprosthesesusingaseriousgameMortenBakKristoffersen,UniversityofGroningen,TheNetherlandsHowtorideahorsewithunilateralcongenitalwristdisarticulationdeficiency–acasepresentationMajaMlakae,UniversityRehabilitationInstitute,Ljubljana,SloveniaMultimodalmeasurementandevaluationontheinfluenceofdonningmyoelectrictransradialprosthesissocketbymeasuringKengoOhnishi,TokyoDenkiUniversity,Saitama,JapanEstimatesofClassificationComplexityforMyoelectricPatternsRecognitionNiclasNilsson,ChalmersUniversityofTechnology,Goteborg,SwedenImprovedmyoelectricclassificationviausinginertialmeasurementunits(IMUs)AgamemnonKrasoulis,UniversityofEdinburgh,Edinburgh,UK

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GUESTSPEAKERS

RickardBrånemarkMD,Msc,PhDDrBrånemarkisaseniorconsultantattheCentreforAdvancedReconstructionofExtremities(C.A.R.E)atSahlgrenskaUniversityHospital,associateprofessorattheDepartmentofOrthopaedics,UniversityofGothenburg,visitingprofessorattheUniversityofCalifornia,SanFrancisco,DepartmentofOrthopaedicSurgeryand co-director of the international Center for Osseointegration Research,EducationandSurgery(iCORES).Hehaspioneeredtheuseofosseointegrationto anchor limb prostheses for more than 20 years. Dr Brånemark has beeninternationallyacknowledged,andwasrewardedwiththeHangerPrizein2007forhiscontributioninamputationresearch.HewasrecentlyawardedtheUCSFPresidentialChairAward2016-2017.

TamarMakinTamarMakin is anAssociate Professor at theNuffieldDepartment of ClinicalNeuroscience of Oxford University. Her group studies plasticity of bodyrepresentation inhealthypopulationsand in individualswithahand-loss.Hermain interest is in understanding how habitual behaviour, such as prostheticlimbusage,drivesbrainreorganisation.Forthispurpose,sheintegratesmethodsfrom the fields of neuroscience, experimental psychology andrehabilitation. Tamar graduated from the Brain and Behavioural SciencesprogrammeattheHebrewUniversityofJerusalemin2009.ShethenjoinedtheUniversityofOxford, firstasaNewton InternationalRoyalSocietyFellowandsubsequentlyasaMarieCurieIntra-EuropeanEarlyCareerDevelopmentFellowto establish her research program on brain plasticity in amputees. She iscurrentlyholdingaWellcomeTrust/RoyalSocietySirHenryDaleFellowship.InOctober2016shewillbejoiningthefacultyofUniversityCollegeLondonattheInstituteofCognitiveNeuroscience.

RaoulBongersDrBongersisAssistantProfessorintheFacultyofMedicalSciencesCenterforHuman Movement at the University of Groningen, The Netherlands. Hisresearch focusses on action-perception learning and development from acombinedperspectiveofEcologicalPsychologyanddynamicalsystemstheory,using uncontrolled manifold analyses and multifractal analyses to assessstability,variability,andinteractiondynamicsoftheaction-perceptionsystem.Hisstudiesexploreprocessestodeterminehownewbehavioursemergeandarestabilized during development and and learning. Dr Bongers uses a taskperspectivetodevelopseriousgamestotrainupperlimbprostheticuse.

CarolGarciaCarol Garcia has been qualified as a physiotherapist since 1987 and workedclinically for nineteen years primarily in acute respiratory care and cardiacrehabilitation. She joinedSheffieldHallamUniversity in2005andwentontocomplete herMA in Teaching and Learning (Post Compulsory Education andTraining) in 2013. Carol teaches cardiorespiratory physiotherapy across theundergraduate and post graduate programs and since joining SHU she hasdeveloped her interest and understanding of the pedagogy that underpinsteaching in higher education. Since 2013, Carol has been developing herresearch skills through working in a multidisciplinary, cross faculty, multiorganisationteamlookingattheuseofvirtualrealityinupperlimbprosthetics.Presentlythisresearchisbeingusedasapilotprojectlookingatthewiderusesofvirtualrealityinhealthcare.

GUESTSPEAKERS





GUESTSPEAKERS





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NorbertKangMrNorbertKanggraduatedfromCharingCross&WestminsterMedicalSchoolin1989.hedidhispre-fellowshipsurgicalrotationinLeeds-Bradford1992-1994andhisMDfellowshipatRAFTInstitute(1995-1997).Hecompletedhisplasticsurgery training inpan-Thames in2002andwasappointedasa consultant in2002.Hehasspecialinterestsinhandsurgery,hypospadiassurgery,prostheticreconstruction(upperlimb)andprominentearcorrection.

LeviJHargroveDr Hargrove received his MScE and PhD in electrical engineering from theUniversity of New Brunswick (2005, 2008). He is a Research Scientist at theRehabilitation Institute of Chicago (RIC), and an Associate Professor in theDepartments of PhysicalMedicine& Rehabilitation andMcCormick School ofEngineeringatNorthwesternUniversity.

DrHargrovecurrentlyisDirectoroftheNeuralEngineeringforProstheticsandOrthotics LabatRIC. His research interests includesignalprocessing,patternrecognition,andmyoelectriccontrolofpoweredprostheses.Amajorgoalofhisresearchistodevelopclinicallyrealizablemyoelectriccontrolsystemsthatcanbemade available to personswith limb loss in the near future. His researchaddressesall levelsofamputationand includes individualswhohavereceivedtargeted muscle reinnervation. Key projects include the development ofadvancedandadaptivecontrolsystemsforprostheticlegs,improvingcontrolofrobotichandprostheses,andintramuscularEMGsignalprocessing.HisworkhasbeenfundedbytheUnitedStatesNationalInstitutesofHealth,NationalScienceFoundation,SpaceandNavalWarfareSystemsCenter,andtheUSArmy.

FrankBowlingFrankBowling isaDoctorofPodiatryworking inbotha surgicaland researchcapacityattheUniversityofManchester,ManchesterRoyalInfirmary.HeholdsanundergraduatedegreeinPodiatry,MScinodiatricSurgeryandaDoctorateinPodiatricMedicineandPhDMedicine.Sincegraduationhehasauthoredandco-authored over 70 papers in a range of medical journals including 12 bookchapters and two books in Pharmacology, Disease Management, DiabeticNeuropathy,Biomechanics,PathomechanicsandCharcotFoot.

ChrisDrakeChrisDrakeisDirector/Owner,ConsultantOrthotistandOrthoticExpertWitnessat Orthotic Experts Ltd – a dedicated OrthoticMedical Legal and ImmediateNeedsReportingConsultancyprovidingexcellenceinmedicallegalreporting.Hehas extensive experience and specialist skills in orthotic principals/practice,lower limb biomechanical dysfunction and posture defects that have beengainedover30yearsofclinicalpractice.Hequalifiedin1983andinitiallyworkedin theprivate sector until 1991. From late 1991 to 2005, heheld thepost ofPrincipalOrthotistandHeadofOrthoticsatQueenMary’sHospitalNHSTrust,LondonSW15.In2005,heformedaprivateclinicalpracticeTheLondonOrthoticConsultancy Ltd where he was Managing Director and Principal ConsultantOrthotistuntilDecember2012.

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ABSTRACTS-Wednesday28September(inorderofpresentation)

Title: Effects of Adding Vibrotactile Feedback to a Myoelectric Controlled Hand on

PerformanceandVisualAttentionwithaDisruptionofVisualFeedbackPresenter: EitanRaveh,BPT,MSc

Departmentofoccupationaltherapy,TelAvivUniversityP.O.Box39040,TelAviv6997801,Israel Tel:+972-54-4252933 E-Mail:[email protected] OtherAuthors:SigalPortnoy,PhD,Departmentofoccupationaltherapy,TAUJasonFriedman,PhD,Departmentofphysicaltherapy,TAUAimsandObjectives:Despiteadvancementsinprosthetictechnology,thelackoftactilefeedbackinupperlimbprostheses isstillachallengeforprostheticusers.Therefore,amputeeshavetoconstantlyuse their visual feedback resources during performance of simple functional tasks. When visualfeedbackisdisrupted,orinadual-taskparadigm,performancelevelsandallocationofvisualresourcesareaffected.Addingvibrotactilefeedback(VTF)totheresiduallimbhasbeenshowntobeaviablemechanismforprostheticusers.However,theeffectsofaddingVTFtoamyoelectriccontrolledhandonperformanceandvisualattentionduringdailytasks,werenotinvestigatedyet.OurobjectivewastoexaminetheeffectsofaddingVTFtoamyoelectriccontrolledhand,duringperformanceofsimplefunctionaltasks,wherevisualfeedbackisdisruptedorduringadual-taskparadigm.

Methods:Twentyhealthysubjectswere instructedtocontrolavirtualcaronaroadpresentedonscreenwiththeirlefthandonthekeyboard.Duringthegame,instructionsforsimplefunctionaltasks,e.g.mixingsugarinaglasswithaspoon,appearedonthescreen.Thesetaskswereperformedwithamyoelectriccontrolledhand,attachedtotheirrighthand.PressuresensorsatthetipsofthehandandvibrotactileactuatorsattachedtotherightarmprovidedthesubjectswithVTFduringgrasping.Weusedaneye-trackingsystemtorecordthevisualattentionof thesubjectduringperformance.Thestudydesignwasarepeatedmeasuresdesignwithcounter-balancedorderoftwoconditions,sothegamewasrepeatedtwice-withandwithouttheVTF.Inaddition,thesubjectsperformedtheBoxandBlockstest,withadisruptionofvisualfeedback.Thiswasdoneusingamotioncapture laboratory,withavirtualpresentationofthetest.Amisleadingvisualfeedbackwaspresentedonascreen,sothat the virtual block randomly fellwhile the actual blockwas still held by the subject. Thus, thesubjectswerecompelledtorelyontheVTFduringgrasping,despitethemisleadingvisualfeedback.Results:Thisisanongoingstudy,whichitscurrentresultsaredetailedbelow.Wearecontinuingthesetrialswithtransradialmyoelectricprosthesisusers.Inthegroupofnon-impairedsubjects,addingVTFwasfoundtoaffectvisualattentionorperformanceinthedualtaskparadigmonlyinsometasks.Forexample,theaveragetime(±standarddeviation)tocompletethesugar-mixingtaskwas13.7±17.2swiththeVTFversus19.3±9.1swithoutthefeedback.Inaddition,thenumberoftimethesubjectshaveshiftedtheirgazefromthescreentowardsthehandwere15.5±23.7withVTFversus20.0±11.6timeswithout the feedback. When examining the subjects with the misleading visual feedback, nodifferencewasfoundinperformancebetweenwithandwithoutVTF.Conclusions: Our interim results suggest that the performance of certain functional tasks, andallocationofvisualattentionresourcesmaybeimprovedbyaddingVTFtoamyoelectrichand.FurtherinvestigationisrequiredtoevaluatetheeffectsofVTFinprosthesisusersandindifferentsituationswherevisualfeedbackisdisrupted.References:1. AntfolkC,D'AlonzoM,RosénB,LundborgG,SebeliusF,CiprianiC.Sensoryfeedbackinupperlimbprosthetics.Expert

RevMedDevices.2013Jan;10(1):45-54 2. SobuhMM,KenneyLP,GalpinAJ,ThiesSB,McLaughlinJ,KulkarniJ,KyberdP.Visuomotorbehaviourswhenusinga

myoelectricprosthesis.JNeuroengRehabil.2014;11(1).

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Title: Myoelectricprosthesisfollowingtotalthumbamputation Presenter: VeraG.vanHeijningen,OccupationalTherapistCHT-NLContact: RijndamRehabilitationInstitute

AtErasmusMedicalCenterWytemaweg803015CNROTTERDAMTheNetherlandsTel:+31107035743E-mail:[email protected]

Otherauthors: RaymonWijman,ProsthetistLivitOrthopedie,Rotterdam,TheNetherlands. VeitBiedermann,Prosthetist,Luttermann,EssenGermany.

W.G.M.Janssen,PhD,MD,RijndamRehabilitationInstituteAtErasmusMedicalCenter,Rotterdam,TheNetherlands.H.J.Stam,PhD,MD,RijndamRehabilitationInstituteAtErasmusMedicalCenter,Rotterdam,TheNetherlands

AimandobjectivesApassive thumbprosthesis is anpossible solution to restorepinchgripandgrip to improvehandfunction,inthumbamputations.Howeverintheclinicalexperienceoftheauthorsthisisnotroutinelyasatisfyingsolutiontothepatientwithatotalthumbloss.Withthedevelopmentsofthei-limbdigits,optionsforimprovementofpartialhanddeficitshasbeenwidened.Theaimofthisstudywasto investigatethepotentialbenefitofapplying amyoelectriccontrolledthumb,inotherwords,willamyoelectriccontrolledthumbimprovehandfunctionincomparisontoapassiveprostheticthumb?Thiscasestudypresentstheprocessandpreliminaryresultsofoptimizingthefunctionofthehandofapersonwithatotalthumbloss.CasedescriptionandmethodsA53-yaeroldwomanreportedwithachiefcomplaintofimpairmentindailyactivities.Thethumbofherrighthandwasamputatedatthelevelofthecarpo-metacarpaljoint,followingaperiodofsufferingseveresymptomsofComplexRegionalPainSyndrometypeIIresultfromacatbite.Herleftarmshowedseveresignsofoveruseasaresultofthelimitedcapacityofherrighthand.ThiscasereportdescribestheprocessofdesigningandmanufacturingamyoelectricthumbprosthesisFindingsandoutcomeThiscase-reportdescribesalsotheprocessofRehabilitationofregainingbalanceduseandinteractionbetweentwohandsindailyactivities.Experiencesoftheadvantagesanddisadvantagesoftheoptions,eithernoprosthesis,passiveprosthesisormyoelectricprosthesis,willbesharedanddiscussed.Conclusion–recommendations-implicationsThemyoelectricthumbrestoredthehandfunctionbeyondexpectationsofthepatient.Theclienthasregainedtheabilitytobefullyactiveinherdailylife,inthemostpractical,comfortableandsecurewayaspossible,furthermoreherself-esteemandself-imagearestrengthensThissuccessfulprostheticcaseisachievedbyapproachingthetreatmentaccessquestionwithanopenmindfortheoutcome,aswellasmaintainingawidelookandlookbeyondthescopeofwhatseemstobepossibleduringthewholeprocess.ClinicalrelevanceNocase-reportorany literatureonwith this topicwas foundby theauthors.Thiscase reporthasidentifiedapotentialimprovementofhandfunction,byusingamyoelectricthumbcomponentsolelyincaseoftotalthumbamputation.

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Title: ImpactofBilateralUpperLimbProsthesisSimulatorsinPre-ProstheticTraining:ACaseStudy

Presenter: DebraLatour,M.Ed.,OTR/LContactAddress: TRSProsthetics Tel:413.519.0636

3090SterlingCircle,StudioA FAX:303.444.5372Boulder,CO80301 E-mail: [email protected]

It appears that the concept of utilizing simulators is underutilized. The body-powered prosthesissimulators used in this case scenario accesses voluntary-opening and voluntary-closing terminaldevices.Asdescribedinthisreflectivecasestudy,theprosthesissimulatorcanbeusedinmultiplestages of prosthetic training. During the initial evaluation, the simulator can be used to comparefunctionandaccessofthetechnologiesforsuccessfulprescriptionandactualclienttrial.Thisevidencecanbevideo-tapedandphotographedtoprovidecompellingevidencejustifyingmedicalnecessitytothefundingstakeholder(s).Thecaregivercanexperiencethediversetechnologiesinordertobetterunderstandtherequirementsofuseandapplicationtofunctionalandbimanualmanipulativetasks.Duringthepreparatoryphase,theusercanadjusttothedemandsofsuspensionandpracticepre-prostheticskills-drillsandactivities.Upondeliveryofthedefinitiveprosthesis,thesimulatorcanbeutilizedtoeducatefamilymembersandcaregiverstovariousstrategiesinordertocompletebimanualtasks.Theseopportunitieswiththesimulatorappeartoenhancecarry-overofstrategiestofacilitateskillacquisitionandappropriationofprostheticsatisfaction.

Mr.Aisa45yearoldmalewhopresentswithacquiredlossofbothfeetandbothhandsduetoillnessattheageof11months.Heworebilateralupper limbprosthesesasachild,abandoninguseafterthreemonths.Hehasaccomplishedmosttasksusingbothresiduallimbs(partialhandlevel,nodigits)atmidline.Thisadaptivestrategyrequiresmoretimeaswellasposturinginthetrunktoaccommodatewhatevertaskhe isattempting.Approximately1yearagoheexpressed interest inactivity-specificdevicesbecauseheperceived thathis currentmethodwas inefficientand theovertposturinghasappearedtocausemidandlowbackpain.TheVC-VOprosthesissimulatorswereusedduringaninitialoccupationaltherapyevaluationtoaccompanytheprosthetistrequest forauthorization.Followinginsuranceapproval,theprosthesissimulatorswereusedweeklyinpre-prosthetictrainingforaperiodofsixweeks.Duringthisperiod,theclientmetallofhisgoals.Atthetimeofdeliveryofhisdefinitiveprostheses,theclientwasimmediatelyabletocompletemanyself-caretasksindependentlyusinghistechnology. He has since engaged in prosthetic rehabilitation to refine skills toward instrumentalactivitiesofdailylivingincludingcareofhisyoungchildren,managementofhishomeandpropertyandeventualreturntowork.

The VC/VO prosthesis simulator was during the pre-prosthetic delivery phase of intervention toaddress skills drills of grasp and release in diverse planes, functional splinter skills and bimanualfunctionaltasks;accompaniedbyworkwiththemirrorboxtooccludevisionandaddresspositioninspace,surface/objectfeatureidentificationandobjectidentification.Itisthoughtthatsuchemphasismayhelptoimprovefunctionaloutcomesandconsumersatisfactionwiththedefinitiveprosthesis,impactuseracceptanceandminimizerejectionoftheprosthesis.ThiscasestudyoftheclientwithbilateralUL limb losswill detail the interventionsused, report functionaloutcomes,perceptionofability/disabilityandclientsatisfactionoftheprothetictechnologyprovidedtohim.

REFERENCES

Atkins,DJ.ComprehensiveManagementoftheUpper-LimbAmputee.(2012)SpringerLondon,Ltd.2011.

WeeksDLetal(2003)TrainingwithanUpperLimbProstheticSimulator;ArchivesofPhysicalMedicineandRehabilitation84.437-443

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Title: A case study in the use of 3D CADCAM system use in the design andmanufactureofforequarterprosthesis

Presenter: MrM.Currie,Prosthetist&MrsL.Powell,ClinicLeadProsthetist

ContactAddress: ARCClinic9,AddenbrookesHospital,HillsRoad,Cambridge

Tel:01223213859E-mail:[email protected]

Aimsofcasestudy:

Thiscasestudyaimedtooutlinetheuseofaninnovativetechniqueofshapecaptureformanufactureofashouldercapprosthesisintwoforequarteramputees.Thetraditionalmethodusedforthislevelofamputationisaplasterofparis(POP)castoftheamputatedsideandacomparativePOPcastofthecontralateral side. The case study set out to ascertain if theuseof 3D scanning improvedpatientsatisfaction (including cosmetic presentation and procedure) and was more efficient than thetraditionalmethods.

Techniques:

Duetotherarityofforequarteramputation,opportunitysamplingwasusedtoselecttwopatients,onemale and one female. Both these patientswere primary forequarter amputees as a result ofcancer.The3DscannerusedforthisstudywasanOmegabyOhioWillowoodinconjunctionwiththeOmegaTracerSoftware,alsofromOhioWillowood.Thepatientswerefullyawareofeachstageoftheprocessandopportunitiesprovidedforquestionsandfeedback.

Thepatientswerescanneddirectlyontotheirskinwiththeuseofreflectivemarkers.Theirentiretorsowasscannedincludingtheunaffectedcontralateralside.Theunaffectedsidewasusedasamodeltoconstructtheshoulderprosthesisfortheamputatedarm.ThescanswererectifiedontheCADCAMsystemandmodelswereproducedfroma foamblockbysendingtherectifiedcomputer files toarobotic carver. The prosthetic shoulder caps were manufactured using the models in the on-siteworkshop.Afittingwascarriedoutwiththepatientpriortothecapsbeingcompletedanddelivered.PatientswererequiredtofilloutaQualityofLifemeasurepostfitting.

Resultssummary:

Theprocessofscanningandrectificationonthecomputersoftwarewasamoreefficientprocessforthe clinician and this meant the patients initial scanning/casting appointment was of a shorterduration. Themanufacturing processwas simplified as only onemodelwas usedwith both sidesreadilycomparableduringshaping.Thefasterscanningprocessalsothatthepatientsmodestycouldbepreserved.Thefactnoplasterwasusedmeanttheprocesswasfarcleanerandnowashingormesspostcasting.Duringthefirstfittingpatientsimmediatelyreportedthatwhenwearingtheprosthesistheypreferredthewaytheylooked.TheQualityofLifemeasureindicatedapositiveimpactonthepatient’sbodyimage.Somecomfortissueswereencounteredduringareviewofoneofthepatients,butthiswaseasilysolvedandwasaresultofnerveissuesduringtheamputationsurgery.

Conclusions/recommendations:

Despite the low subject numbers, the initial results were very positive. Firstly the scanning andmanufacturing process was much simpler than previous POP techniques. Secondly, the overallcosmesisimprovedandfewerfittingswererequiredthaninprevioustechniques.Finally,thepatientssatisfaction was much improved and the computer visuals allowed simplified explanations of theprocesstothepatientsandfamilies.

As a result of this, 3D CADCAM shape capture should be used for scanning and more accuratemanufactureofshouldercapprosthesisforforequarteramputees.

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Title: TheImpactofPartialHandAmputation–ACasePresentationPresenter: MrsLindseyBarker,ClinicalSpecialistOccupationalTherapistContactaddress: HaroldWoodLongTermConditionsCentre ClementsAvenue,offGubbinsLane HaroldWood,Romford,EssexRM30ARTelno: 01708576211Faxno: 01708576201Emailaddress: [email protected] can impactonall aspectsof an individual'swell-being,qualityof life andoccupation.Thelossofahand,becauseofitshighlysymbolicandmulti-functionalnature,isknowntobemoretraumaticthanthelossofaleg.(RybarczykBetal2008).Thispresentationwillexplorethroughacasestudy,theimpactoftraumaticpartialhandamputationon an individual and explore the types of prosthesis provided. The presentation will include theindividual'sprogressthroughtheirjourneyfollowinginjuryandamputation,describingoccupationaltherapyintervention,andamulti-disciplinaryapproachtotreatment.OccupationalperformanceoutcomeswillbepresentedusingtheCanadianoccupationalperformancemeasure(Lawetal2014).Theclinicalreferencegroupforcomplexdisability,equipment–prosthetics(2013)referstotheimpactthattheappearanceaprosthesismayhaveonthesuccessfulprostheticrehabilitationofapatient.Itiscurrentlydifficult forclinicians toobtain funding forhighdefinitionsiliconeprostheses,and it isanticipated that this presentation will highlight the effect of amputation on body image and theimportanceofprovidingarealisticandacceptableprosthesistotheindividual. Itwillbediscussedthatthisinturnmayhaveapositiveinfluenceonanindividual’soccupationalperformance.References: RybarczykB,BehelJ(2008)PsychoprostheticsChapter3-LimbLossandBodyImage

Chapter3pg24Springer

Law M, Baptiste S et al (2014) Canadian Occupational Performance Measure 5thEditionCanadianAssociationofOccupationalTherapyACEPublications

NHSEnglandClinicalReferenceGroupforComplexDisability,Equipment–Prosthetics(2013) Clinical Commissioning Policy: Provision of custom made high definitionsilicone covers for prosthetic limbs and partial hand prostheses ReferenceNHSCB/DO1/S/dNHSEngland

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Title: MyoelectricarmprosthesisapproachinchildrenattheJapanHyogoRehabilitationCenter

Presenter: YaekoShibata,OT,Ms

Address: HyogoRehabilitationCenter,DepartmentofOccupationalTherapy,1070Akebono-cho,Nishi-ku,Kobe,Japan,651-2181Tel＆Fax:+81-78-927-2727E-mail:[email protected]

OtherAuthors: F.Mizobe1),T.Chin1）,J.Oba2)

1）HyogoRehabilitationCenter 2）KobeGakuinUniversity

Background

In the West, early aggressive training with myoelectric arm prosthesis has been reported to beeffectiveforchildrenthatlostanarmduetoaccidentandchildrenwithbirthdefects.Thisistoenablethe children to personally decidewhether theywant to live using a prosthetic arm in the future.Although theapproach in Japanhasbeen inadequate, trialswithmyoelectric armprosthesis frominfancywerestartedfrom2002attheHyogoPrefectureRehabilitationCenterandthatapproachisstillinplace.

Aim

Toclarifythetrendin50childrenwhounderwenttrainingusingmyoelectricarmprosthesisatthisinstitutionin2002-2014.Tointroducetheapproachandprogressofmyoelectricarmprosthesisforchildrenandreporttheusagefeaturesandeffectivenessofusingmyoelectricarmprosthesisinreal-lifesettingbyage.

Method

Fiftychildrenwhohadlost(amputation)anarmthatwereexaminedattheHyogoPrefectureCentralRehabilitationHospitalandhadstartedtrainingwithamyoelectricarmprosthesisin2002-2014werethesubjects.Therewere26malesand24females.Eighteenhadlosttherightarmand32theleftarm.Causeofthelosswascongenitallossofanarmin49childrenandamputationduetotraumainonechild.Alltrainingwasout-patientbasedandonesessionwasapproximately60min.

Results

Fortyfivechildrencontinuedusingmyolectricarmprosthesisand5discontinuedtheuse.Infantswerestartedfromtheuseofdecorativeprostheticarms,thenintroducedtoone-electrodecontrolledand3-electrodecontrolledmyoelectricarmprosthesis from1yearofageand3yearsofageonwards,respectively.Methods of play according to agewere introduced focusing on grip training such asopeningandclosingofthehand,andplayingwiththeuseofbothhands.Moreover,notonlyuseoftheprosthesisathome,butmotionsofusingitinsociallifesuchasinthenurseryandkindergartenwereactivelyconducted.

Discussion&Conclusion

Bywearingaprostheticarmandusingitindailylifefromearlystages,childrenwillwanttousebothhandstoaccomplishtasks,andwillhavemanyopportunitieswheretheycanexperienceenjoymentinplaying.Increaseddesiretooptforaprostheticarmleadstoimprovementinthequalityoflifeofthepersonaffected.Astheroleandmethodsofuseofaprostheticarmchangesasachildgrows,continuedperiodicalfollowupandapproachesareindispensiblewithmyoelectricarmprosthesisforchildren.

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Title: LatestdevelopmentsintheuseofOsseointegratedupperlimbprosthesesPresenter: RickardBrånemark,MD,MSc,PhD,FRSM CenterofAdvancedReconstructionofExtremities(CARE) CenterofOrthopaedicOsseointegration(COO) DepartmentofOrthopaedics SahlgrenskaUniversityHospital UniversityofGothenburg SU/Molndal,Sweden 43180Molndal,Sweden InternationalCentreforOsseointegrationResearch,EducationandSurgery(iCCORES) DepartmentofOrthopaedics UniversityofCalifornia,SanFrancisco,USA Directly bone anchored prostheses according to the osseointegration concept were originallydeveloped by the late Professor P-I Brånemark in Gothenburg in the 1960. Osseointegration wasinitiallyusedtotreatedentulism.Inamultidisciplinaryapproachosseointegrationhasbeenimplementedfordirectskeletalanchorageof amputation prostheses since 1990. Initially, the focus was on individuals with transfemoralamputations.However,theosseointegrationconceptisnotrestrictedforusetothelowerextremity.The treatment offers unique opportunities on the upper extremity to combine anchorage withadvancedprostheticcontrolusingimplantedelectrodes.Thispresentationwillgiveanoverviewofpastworkandongoingresearchanddevelopment.

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Title: PPP-Arm:theimplementationofanationalProsthesisPrescriptionProtocol

Presenter: P.A.Wijdenes,OccupationalTherapist,Mrs.

Address: UniversityMedicalCenterGroningen,DepartmentofRehabilitationMedicine Hanzeplein1,9713CZGroningen,TheNetherlands

Tel:0031503613656

E-mail:[email protected]

OtherAuthors:1)M.A.H.Brouwers,MD,DeHoogstraatRehabilitation,Utrecht,TheNetherlands2)ProfessorC.K.vanderSluis,MDPhD,UniversityofGroningen,UniversityMedicalCenterGroningen,DepartmentofRehabilitationMedicine,Groningen,TheNetherlands

Introduction:Patientswithanacquiredorcongenitalupperlimbdefectneedhighlyspecializedcarefrommultidisciplinaryteams.IntheNetherlands,variousrehabilitationcentershadtheirownmethodoftreatment.Standardizedcareforthesepatientswasnecessary,especiallywhenprescribingprostheses.

Aim:Tocreateandimplementanationaldigitalprotocolforprescribingupperlimbprostheses.

Method:TheProsthesisPrescriptionProtocoloftheupperlimb(PPP-Arm)isatooltostructure,underpinandevaluatetheprescriptionofupperlimbprostheses.TheprotocolisbasedonWHO’scriteriaoftheInternationalClassificationofFunctioning(ICF)andconsistsofthefollowinglayers:

1.Establishingpatient’sdemands;2.Establishingdevicerequirements;3.Preparationoftreatmentrequirements;4.Selection,try-outandfinaldecision;5.Deliveryofthedevice;6.Instructionsandtraining;7.EvaluationResultsofimplementation:Theprotocolhasbeencreatedthroughthecollaborationofpatients,rehabilitationteams,orthopedicworkshopsandinsurancecompanies,collaboratingintheworkinggroupPPP-Arm.ImplementationstartedinfourrehabilitationteamsintheNetherlands.Afteroneyearanothersixrehabilitationteamsstartedusingtheprotocol.Ineachteamaknowledgebrokerwasappointed,whowasresponsiblefortheimplementationwithinhisowncenter.Anationalprojectcoordinatormaintainedcontactwithallpartiesinvolved,collectedquestionsandproblemswhenusingtheprotocol,organizedactivitiesandmeetingstodeveloptheprotocolfurtherandtostimulateusingtheprotocol.InthelastyearoftheprojectwehavedevelopedthefolderInformation.Inthisfolderlinkscanbefoundtoeducationalmaterialsforclientsaboutforexample:amputation,phantomsensations,upperlimbprostheses,personalcareandpeercontact.

TheprotocolalsohasbeentranslatedinEnglishanditispossibletousethisversioninothercountries.Advantagesoftheprotocolarecompleteandstructured;user-friendly;usingthesameICFterminologyandthesametreatmentguidelinesbyallusers;appliednationally;digitalreporting;workplaceindependentloginpossibilitiesforallteammembers;prescriptionreportsforinsurancecompanies;patientsgainmoreinsightintheirowntreatmentprocess;buildinganationaldatabaseforresearch.

Disadvantagesoftheprotocolaretimeinvestmentisneededtolearnusingtheprotocol

Evaluation:TheuseofPPP-Armhasbeenevaluatedusingaquestionnaire:

- PPP-Armisusedbyallparticipatingcenters- Thequalityoftheprosthesisapplicationshasimproved- PPP-Armhasproducedaseveralpositivedevelopments:betterteamcooperation,more

structureandcompleteness,moreuniformityinthecountry,trialperiod.

Conclusion:ThenationwideimplementationprojectPPP-Armwassuccessful,sinceallparticipatingcentersusetheprotocol.BydevelopingPPP-Armwehavemanagedtocreateanationaluniformandstructuredmethodtoadviseandevaluatetheprescriptionofupperlimbprostheses.

Title: PPP-Arm:theimplementationofanationalProsthesisPrescriptionProtocol

Presenter: P.A.Wijdenes,OccupationalTherapist,Mrs.

Address: UniversityMedicalCenterGroningen,DepartmentofRehabilitationMedicine Hanzeplein1,9713CZGroningen,TheNetherlands

Tel:0031503613656


Other Authors : 1) M.A.H. Brouwers, MD, De Hoogstraat Rehabilitation, Utrecht, The Netherlands2)ProfessorC.K.vanderSluis,MDPhD,UniversityofGroningen,UniversityMedicalCenterGroningen,DepartmentofRehabilitationMedicine,Groningen,TheNetherlands

Introduction:Patientswithanacquiredorcongenitalupperlimbdefectneedhighlyspecializedcarefrommultidisciplinaryteams.IntheNetherlands,variousrehabilitationcentershadtheirownmethodof treatment. Standardized care for these patients was necessary, especially when prescribingprostheses.

Aim:Tocreateandimplementanationaldigitalprotocolforprescribingupperlimbprostheses.

Method: The Prosthesis Prescription Protocol of the upper limb (PPP-Arm) is a tool to structure,underpinandevaluatetheprescriptionofupper limbprostheses.Theprotocol isbasedonWHO’scriteriaoftheInternationalClassificationofFunctioning(ICF)andconsistsofthefollowinglayers:

1.Establishingpatient’sdemands; 2.Establishingdevice requirements;3.Preparationof treatmentrequirements; 4. Selection, try-out and final decision; 5.Delivery of the device; 6.Instructions andtraining;7.EvaluationResults of implementation: The protocol has been created through the collaboration of patients,rehabilitationteams,orthopedicworkshopsandinsurancecompanies,collaborating intheworkinggroupPPP-Arm.ImplementationstartedinfourrehabilitationteamsintheNetherlands.Afteroneyearanothersixrehabilitationteamsstartedusingtheprotocol.Ineachteamaknowledgebrokerwasappointed,whowas responsible for the implementationwithinhisowncenter.Anationalprojectcoordinator maintained contact with all parties involved, collected questions and problems whenusingtheprotocol,organizedactivitiesandmeetingstodeveloptheprotocolfurtherandtostimulateusingtheprotocol.InthelastyearoftheprojectwehavedevelopedthefolderInformation.Inthisfolderlinkscanbefoundtoeducationalmaterialsforclientsaboutforexample:amputation,phantomsensations,upperlimbprostheses,personalcareandpeercontact.

TheprotocolalsohasbeentranslatedinEnglishanditispossibletousethisversioninothercountries.Advantages of the protocol are complete and structured; user-friendly; using the same ICFterminology and the same treatment guidelines by all users; applied nationally; digital reporting;workplace independent loginpossibilities forall teammembers;prescriptionreports for insurancecompanies;patientsgainmoreinsightintheirowntreatmentprocess;buildinganationaldatabaseforresearch.

Disadvantagesoftheprotocolaretimeinvestmentisneededtolearnusingtheprotocol

Evaluation:TheuseofPPP-Armhasbeenevaluatedusingaquestionnaire:

- PPP-Armisusedbyallparticipatingcenters- Thequalityoftheprosthesisapplicationshasimproved- PPP-Arm has produced a several positive developments: better team cooperation, more

structureandcompleteness,moreuniformityinthecountry,trialperiod.

Conclusion:ThenationwideimplementationprojectPPP-Armwassuccessful,sinceallparticipatingcentersusetheprotocol.BydevelopingPPP-Armwehavemanagedtocreateanationaluniformandstructuredmethodtoadviseandevaluatetheprescriptionofupperlimbprostheses.

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Title Forming an international consortium for sharing resources of upper limb absence

worldwide-thehandsmartgroupPresenter LiselotteNHermansson1,2,3,AssociateProfessorContact Deptof Prostheticsand Tel:+46196025576 Address Orthotics

Fax:+46196021000

V-building

E-mail:

ÖrebroUniversityHospital [email protected]

SE70185Örebro,Sweden

Other Thehandsmartgroup* authors

Affiliations 1FacultyofMedicineandHealth,ÖrebroUniversity,Örebro,Sweden 2DepartmentofProstheticsandOrthotics,RegionÖrebroCounty;and 3University HealthCareResearchCentre,RegionÖrebroCounty;

Örebro,SwedenIntroductionAn exciting and constantly changing environment in the upper limb prosthetics field challengesclinical teams on a daily basis. Prosthetic devices and control systems, as well as individual’srequirementsandexpectations,havechangedanddevelopedoverthepastseveralyears.Tomeetorexceed expectations, and to obtain the best outcomes in a coordinated clinical care continuum,therapistsneedtohavefoundationalskillsandknowledge.Theaimofthisworkistodeterminebestclinicalpracticeandtoprovideresourcesfortherapists.MethodsTheprostheticcompanyOttobockinitiatedameeting inBerlin,Germany, inFebruary2016.Twelveindependent international experts consisting of 11 therapists (4 physical and 7 occupationaltherapists) and 1 prosthetist, from different parts of theworld, participated. The clinicians are alleither independent practitioners or working with a company and specialized in upper limbloss/differencerehabilitation,eitherinclinicalorresearchsettings.Discussionswerefacilitatedbyanindependentmoderator.Decisionsweremadebasedonvotingandconsensusagreements.ResultsThe international consortium of expert clinicians were united in the vision to provide the mostholisticrehabilitationapproachforeverypersonwithupperlimblossorupperlimbdifference,nowand in the future. Based on this agreement the “handsmart group” was formed and furtherdiscussionstookplace.The vision was operationalized by the mission to support and empower clinicians and patientsworldwide by creating and updating an open access, easily understandable resource based onevidence, for those engaged in upper limb loss/difference rehabilitation. The consortium formedworking groups to address the following objectives; 1) create an online platform for networking,sharing information, communicating and accessing resources for supporting clinical practiceinternationally;2)searchandapplyforfinancialsupportforthefutureactivitiesinthegroup;and,3)search, compile and recommend interventions for different rehabilitation phases, in adults andchildrenwithupperlimbabsence.

23

DiscussionSome clinicians have difficulty accessing information or relevant findings in upper limbloss/difference rehabilitation. They usually receive their knowledge from peers, by trial and errorover the years or reading materials in some special fields. The handsmart platform will provideevidencebasedresourcesthatareeasytounderstandandaccessibleworldwide.Hopefullythiswillimprovethequalityofupperlimbrehabilitation.Thehandsmartgroupisanon-profitgroup,andthemembersareworkingonavoluntarybasis.Weinvite external parties involved in upper limb loss/difference rehabilitation (e.g. patientsorganizations, commercial companies, professional organizations, other team members) tocollaborateandsupportthegroup.Thismayenablesuccessfulworkinpromotionofourmissionandvision.

DisclosureThough Ottobock initiated and was in charge of organizing and supporting the first meeting, thehandsmartgroup is independentandfollows internationalneedsand interestsofallpeople.Therearenofinancialinterestsofthisgroup.AcknowledgementsThe authors thankMartin Schöppl for initiating this project, Christiane Jodl for organizing the firsthandsmartgroupmeetingandClaudiaHerczegforfacilitatingthemeeting.WethankKarenRoberts,BambiLombardiandJoyceTylerforsupportingtheidea.

*Members of the handsmart group: Birgit Bischof1, Liselotte Hermansson2, Julie Klarich3, DebraLatour4,AyalaNota5,SandraRamdial6,EitanRaveh7,AgnesSturma8,ShawnSwansonJohnson9,KristiTurner10,ClaudiaWinkler11,DanielaWüstefeld12,DianeAtkins13,PaulaWijdenes14,andWendyHill15*Members affiliations: 1OttoBockAustriaGmbH,Austria, 2FacultyofMedicine andHealth,ÖrebroUniversity, and Region Örebro county, Örebro, Sweden, 3Presbyterian/St. Luke's Medical Center,USA, 4Single-Handed Solutions, USA, 5Sheba medical center, Israel, 6Holland Bloorview KidsRehabilitation Hospital, Canada, 7Occupation therapy department, Tel Aviv University, Israel8ChristianDoppler Laboratory for Restoration of Extremity Function,MedicalUniversity of Vienna,and University of Applied Sciences FH Campus Wien, Austria, 9SSJ Rehab Services, PLLC, USA,10Rehabilitation Institute of Chicago, Center for Bionic Medicine, USA, 11Pohlig GmbH, Germany,12Otto Bock HealthCare GmbH, Germany, 13Department of Physical Medicine and Rehabilitation,Baylor College of Medicine, Houston Tx, USA, 14University Medical Center Groningen, TheNetherlands, 15Institute of Biomedical Engineering, University of New Brunswick, Fredericton,Canada.

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Title:Developingatesttodeterminequalityofproportionalcontroloveramyoelectricprosthetichand Presenter:AnniekHeerschop1,MSc.,PhD-student ContactAddress:CenterforHumanMovementSciences Phone:0503616027

UMCG,UniversityofGroningen E-mail:[email protected] A.Deusinglaan1 9713AVGroningen Buildingroom3216-213 Int.mailcodeFA23

OtherAuthors: C.K.vanderSluis2,MDPhD,ProfessorofRehabilitationMedicineE.Otten1,MScPhD,ProfessorofNeuroMechanicsandProstheticsR.M.Bongers1,MScPhD,AssistantProfessor 1 UniversityofGroningen,UniversityMedicalCenterGroningen,CenterforHumanMovementSciences,Groningen,theNetherlands

2 UniversityofGroningen,UniversityMedicalCenterGroningen,DepartmentofRehabilitationMedicine,Groningen,theNetherlands

This study aimed to develop a test that can determine the quality of proportional control over amyoelectric prosthetic hand early in the rehabilitation process. Therefore, multiple tests with andwithoutaprosthetichandbutallcontrolledusingthesEMGoftheflexorandextensorofthewrist,werecomparedintwoexperiments.InExperiment1,31participantsperformedfivetestsinrandomorderinonesession,withouttraining.Thetestscomprisedtwoseriousgamesinwhichobjectshadtobecaught,two tests in which a prosthesis-simulator was used to either pick up rigid objects or to reach certainopening-andclosingspeeds,andonetestmatchingtheEMGwithapre-programmedline.Correlationsbetweentheperformanceofalltestsshowedonlyoneweakcorrelation.Inordertoassesstheeffectofashorttrainingperiod,inExperiment2,12participantstrainedtwotestsfor12minutesperdayonfiveconsecutivedays.Wecomparedperformancein(1)aprosthesistaskinwhichaprosthesis-simulatorwasusedtopickupcompressibleobjectsand(2)aseriousgame inwhichobjectshadtobecaughtwithagrabber while receiving ADL-relevant feedback. Earlier we showed skill-improvement in this gametransfers to prosthesis use. Results showed no correlation between the tests for multiple outcomemeasures.Combined,theexperimentsshowthatperformanceinonetestisnotrelatedtoperformancein another test. This indicates the quality of proportional control over a myoelectric prosthetic handshouldbetestedusingaprosthesistask.

Title:Developingatesttodeterminequalityofproportionalcontroloveramyoelectricprosthetichand Presenter:AnniekHeerschop1,MSc.,PhD-student ContactAddress:CenterforHumanMovementSciences Phone:0503616027

UMCG,UniversityofGroningen E-mail:[email protected] A.Deusinglaan1 9713AVGroningen Buildingroom3216-213 Int.mailcodeFA23

OtherAuthors: C.K.vanderSluis2,MDPhD,ProfessorofRehabilitationMedicineE.Otten1,MScPhD,ProfessorofNeuroMechanicsandProstheticsR.M.Bongers1,MScPhD,AssistantProfessor 1 UniversityofGroningen,UniversityMedicalCenterGroningen,CenterforHumanMovementSciences,Groningen,theNetherlands

2 UniversityofGroningen,UniversityMedicalCenterGroningen,DepartmentofRehabilitationMedicine,Groningen,theNetherlands

This study aimed to develop a test that can determine the quality of proportional control over amyoelectric prosthetic hand early in the rehabilitation process. Therefore, multiple tests with andwithoutaprosthetichandbutallcontrolledusingthesEMGoftheflexorandextensorofthewrist,werecomparedintwoexperiments.InExperiment1,31participantsperformedfivetestsinrandomorderinonesession,withouttraining.Thetestscomprisedtwoseriousgamesinwhichobjectshadtobecaught,two tests in which a prosthesis-simulator was used to either pick up rigid objects or to reach certainopening-andclosingspeeds,andonetestmatchingtheEMGwithapre-programmedline.Correlationsbetweentheperformanceofalltestsshowedonlyoneweakcorrelation.Inordertoassesstheeffectofashorttrainingperiod,inExperiment2,12participantstrainedtwotestsfor12minutesperdayonfiveconsecutivedays.Wecomparedperformancein(1)aprosthesistaskinwhichaprosthesis-simulatorwasusedtopickupcompressibleobjectsand(2)aseriousgame inwhichobjectshadtobecaughtwithagrabber while receiving ADL-relevant feedback. Earlier we showed skill-improvement in this gametransfers to prosthesis use. Results showed no correlation between the tests for multiple outcomemeasures.Combined,theexperimentsshowthatperformanceinonetestisnotrelatedtoperformancein another test. This indicates the quality of proportional control over a myoelectric prosthetic handshouldbetestedusingaprosthesistask.

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Title: EvolutionofRefinedClothespinRelocationTestforProsthesisUsers foruseasaClinicalAssessment

Presenter: AliHussaini,ResearchAssistant,Mr

ContactAddress: InstituteofBiomedicalEngineering(IBME)Tel:+1.506.458.7025

UniversityofNewBrunswick Fax:+1.506.453.4827

Fredericton,NB,Canada Email:[email protected]

E3B5A3

OtherAuthors: WendyHill,ResearchOccupationalTherapist,IBME

Dr.PeterKyberd,ChairandHeadofDepartment, DepartmentofEngineeringScience,UniversityofGreenwichThis study details the development phase of a new upper limb prosthetics outcome measure, theRefinedClothespinRelocationTest (RCRT) forclinicalassessment.Theprimaryfocuswastodevelopastandardized outcome measure that could be performed in a prosthetics clinic within a 20 minutesession.ThetestutilizesamodifiedRolyanGradedPinchExerciser,atimer,andasinglevideocamera.Theuser isasked to relocate3clothespinsbetweenhorizontalandvertical rods, ina setorder,whiletheircompensatorymotionsaregradedbyaclinicianandthetimetocomplete isrecorded.5trials intwodirections(movingtheclothespinsupwardfromthehorizontalrodontotheverticalandviceversa)are completed and the average times of upward and downward directions, as well as the averagecompensatory motion grade are calculated. A clinical assessment relies on these two metrics.Compensatory motion grade is based on the lateral tilt of the trunk and the over rotation of theshoulder(integerscaleof1-4,foreachmotion).In thispilotstudy,42able-bodiedsubjectsand5assessments fromprosthesesusers (myoelectricandbody-powered, transradial and transhumeral) have been performed. Paired sample t-tests (p=0.05)indicatethatside-dominanceisnotafactorintermsoftimetocompleteforable-bodiedsubjects,whichwillallowdatatobepooledfrom lefthandedandrighthandedprosthesisusers.Theprosthesisuserspresented with larger compensation in their torso and shoulder movements (lower grade forcompensations),andalongermeantimetocomplete(2.75timeslonger).Themeantimetocomplete(summation of upward and downward) for able-bodied and prosthesis users were 12.23 seconds and33.57seconds.Averagegradeacrosstheable-bodiedsubjectsforlateraltiltandshoulderrotationwere4 and 4, respectively (lowest possible compensation score). The average grade across the prosthesisassessmentsforlateraltiltandshoulderrotationwere3and3.Utilizing the compensatory motions a prosthesis user makes when performing an assessment, inaddition to time, provides greater insight into the quality of prosthesis usage. Improved controlstrategiesandadvancedprosthesisdesignsareexpectedtoreducetheneedforcompensatorymotions,as well as a lower times to complete. This will only result with improved intuitive control, reducedcognitiveeffort,andreducedcompensations.Forthesubjectsthathavepartakeninthe

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study, it was observed that faster attempts to complete the RCRT resulted in more compensatorymotions(bothgroups).ManysubjectshavecommentedthatthetimecommitmentrequiredtocompleteallpartsoftheRCRT(instructions, test, patient-reported outcome survey) was reasonable or shorter than expected.Prosthesis users also had similar comments, and reported that the instructions were clear, the visualaidswerehelpfulandthelengthoftimetocompletethetestwasmoreagreeablethanotherteststheyhadpreviouslyparticipatedin.TheRCRTisaclinicalmeasurewhichaimstodeterminewhetheraprosthesisuserislikelytousetheirprosthesiswithallavailabledegreesoffreedomandfunctionalitytoreducecompensationsoutsidetheclinic.

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Title: AnExplorationoftheCorrelationbetweenanamendedBoxandBlocksAssessment,thestandardBoxandBlocksAssessmentandtheAssessmentofCapacityforMyoelectricControl,withmyoelectricprosthesisusers.

Presenter: MelissaJacobs,OccupationalTherapistTel:02084876139

Address: QueenMary’sHospital,Roehampton,London,SW155PN

E-mail: [email protected]

Background:Myoelectricprosthesesareapopularchoiceforupperlimbamputeesastheycombinefunctionwithcosmesis.However,costsandrejectionratesassociatedwiththeseprosthesesarehigh.Furthermore,myoelectricprosthesesarenotavailabletoallupperlimbamputeesontheNHS(Watveet al.,2011).Additionally,NHSEngland recently concluded that therewas insufficient evidence tojustify the routine commissioning of newer multi-articulating models (2015). Widespread use ofstandardised outcomemeasureswhich have been validated for this populationmay enablemoreeffectivecomparisonsbetweendifferentprostheses,therebyfacilitatingdevelopmentoftheevidencebaseandguidingprostheticprescription.Yet,theevidencebaserelatingtooutcomemeasuresforthispopulationislimited.Furthermore,onlyoneassessmenthasbeendesignedandvalidatedspecificallyforusewithmyoelectricprostheses–TheAssessmentofCapacity forMyoelectricControl (ACMC).Although a valid and reliable measure of myoelectric prosthetic ability, this assessment remainsinaccessible to many clinicians’ in the UK, due to high training costs and the level of previousmyoelectricexperiencerequired.Therefore,alternativewidelyavailableandcosteffectivemeasuresareneeded.Previousstudieshaveidentifiedgenericmanualdexterityassessments,suchastheBoxandBlocks,ashavingpotentialforusewiththisclientgroup.However,furtherresearchisindicated.

AimsandObjectives:

• ToamendtheBoxandBlocksassessmentformyoelectricprosthesisuserswiththecreationofawoodeninsertandstandardised,gradedpositioningofblocks.

• ToassessparticipantsusingtheACMC,standardandamendedBoxandBlocksassessments.• Tocorrelatescoresfromtheamendedandstandardversion,withtheACMC.

Methods:Relevantethicalandtrustapprovalswereobtainedpriortocommencementofthestudy.Participantswererecruitedusingconveniencesampling.ParticipantscompletedtheACMC,standardand amended Box and Blocks assessments on two occasions, two months apart. Scores werecorrelatedbetweenthestandardBoxandBlocksandACMC,amendedBoxandBlocksandACMCandthestandardandamendedBoxandBlocks.

Results:14Participantswere recruited.Correlationswereas follows:AmendedBoxandBlocksv’sACMCr=0.69,StandardBoxandBlocksv’sACMCr=0.79,Standardv’sAmendedBoxandBlocksr=0.93.Thecombinedp–valueforthecorrelationswas=0.238.Thisstudywasunderpowered.

Conclusion:Thecorrelationsobservedwerestrong.ThecorrelationobservedbetweentheACMCandthestandardBoxandBlockswashigherthantheamendedBoxandBlocksandtheACMCwhichwasunexpected.However, thedifferencebetweenthecorrelationswasnotstatisticallysignificant.TheresultssupporttheexistingliteratureregardingthepotentialoftheBoxandBlocksassessmentwith

ThispresentationwillprovideanoverviewoftheresearchundertakenaspartofaMastersofResearchinClinicalPracticeandprovideaninsightintotheresearchprocessformtheperspectiveofanoviceresearcher.References:NHSEngland(2015)ClinicalCommissioningPolicy:Multi-gripUpperLimbProsthetics.Availableat:http://www.england.nhs.uk/commissioning/wpcontent/uploads/sites/12/2015/07/d01pc-multi-grip-uppr-limb.pdf(Accessed:24August2015).Watve,S.,Dogg,G.,MacDonald,R.andStoppard,E.(2010)‘Upperlimbprostheticrehabilitation’,OrthopaedicsandTrauma,25(2),pp.135-142.

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Title: Developmentandreliabilitytestingofaqualitativescoreforratingcompensatorymovementsinupperlimbprosthesiswearersduringexecutionof4FCE-tests.

Presenter: T.M.J.vanderLaan,MScContactaddress:

UniversityMedicalCenterGroningen,DepartmentofRehabilitationMedicine Tel: 0031(0)503613615

POBox30001 Fax: - 9700RB,Groningen E-mail: [email protected] TheNetherlands [email protected]: SietkeG.Postema,MichielF.Reneman,RaoulM.Bongers,CorryK.vanderSluisAuthors&affiliationsTallieM.J.vanderLaanMSc1,SietkeG.PostemaMSc1,Prof.MichielF.RenemanPhD1,RaoulM.BongersPhD2,Prof.CorryK.vanderSluisMDPhD1

1. University of Groningen, University Medical Center Groningen, Department of RehabilitationMedicine,Groningen,TheNetherlands2. University of Groningen, University Medical Center Groningen, Center for Human MovementSciences,Groningen,TheNetherlandsBackgroundMusculoskeletal complaints (MSC) are twice as prevalent in persons with an upper limb defectcomparedtothegeneralpopulation.Overuseofthesoundlimborcompensatorymovementsoftheaffectedlimbmayexplainthisdifference.ObjectivesTo develop 1) a qualitative scoring system for rating compensatory movements in upper limbprosthesiswearersduringtheperformanceoffunctionalcapacityevaluationtestsadjustedforonehanded individuals (FCE-OH), and to determine 2) the inter- and interrater reliability and 3) thefeasibilityofthescoringsystem.MethodsThescoringsystemwasdevelopedinthreesubsequentstepsfollowinganinternationalguidelineforinstrument development. Twelve (inter-) national FCE-experts, 6 physiotherapists, 12 upper limbprosthesis wearers, and 20 healthy controls were involved in the development. During reliabilitytesting the raters scored videotapes of participating upper limb prosthesis wearers and controls,performing 4 FCE-OH tests two times (two weeks apart), using the developed scoring system.Feasibilitywasdeterminedbyusingaquestionnaire.ResultsKappavalueforintraraterreliabilitywas0.77.Kappavaluesforinterraterreliabilityinthefirstandsecondratingsessionswereк=0.54andк=0.64,respectively.Feasibilitywasratedasgoodtoexcellent.ConclusionsAfeasiblescoringsystemwasdevelopedtoassesscompensatorymovementsinupperlimbprosthesiswearers when executing FCE-OH tests. Intrarater reliability was good, interrater reliability wassatisfactoryinmostinstances.ThestandardizedscoringsystemforassessingcompensatoryupperlimbmovementsduringperformanceofFCE-OHtestsmayprovideclinicianswithuseful information forpreventionandtreatmentofMSCinupperlimbprosthesiswearers.

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Title: Developmentofafunctionalcapacityevaluationmeasurementforindividualswith

upperlimbreductiondeficiencyoramputation.Presenter: C.K.vanderSluisContactaddress:

UniversityMedicalCenterGroningen,DepartmentofRehabilitationMedicine Tel: 0031(0)503613615

POBox30001 Fax: - 9700RB,Groningen E-mail: [email protected] TheNetherlands [email protected]: S.G.Postema,R.M.Bongers,M.F.RenemanAuthors&affiliationsS.G.Postema1,R.M.Bongers2,M.F.Reneman1,C.K.vanderSluis1.1. University of Groningen, University Medical Center Groningen, Department of RehabilitationMedicine,Groningen,theNetherlands.2. University of Groningen, University Medical Center Groningen, Center of Human MovementSciences,Groningen,theNetherlands.BackgroundMusculoskeletalcomplaintsareafrequentprobleminindividualswithupperlimbabsence(ULA).AninstrumentthatassessesphysicalforceandrepetitioncapacityinindividualswithULAiswarranted.AimsObjectives of this study were to develop and pilot test a functional capacity evaluation (FCE) forindividualswithULA,duetoanupperlimbreductiondeficiencyoramputation,andtocomparetestresultswithmatchedcontrols.MethodAnexistingFCEbasedonriskfactorsforwork-relatedupperlimbdisorderswasadaptedforuseinone-handedindividuals,withorwithoutaprosthesis.TheadaptedFCEwaspilottestedby20individualswithULA(ofwhich10withabelowelbowULAand10withanaboveelbowULA;17males,andameanageof46.3(SD:10.5)),and20matchedcontrols.ResultsTheadaptedFCEwasnamedFCE–one-handed(FCE-OH)andconsistsofthefollowingtests:overheadlifting one-handed and two-handed, overheadworking, repetitive reaching, fingertip dexterity andhandgrip strength. IndividualswithULA lifted significantly lessweight compared to theirmatchedcontrols.Nosignificantdifferencesfortheothertestswerefound.Discussion&conclusionTheFCE-OHteststhefunctionalcapacityoftheupperextremitiesofone-handedindividuals,withorwithout a prosthesis, in a standardized environment. It will allow healthcare professionals toobjectively assess the physical capacity of an individual with ULA and to give these individualssubstantiatedadviceregardingsuitablework.

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Title: Areflectivecasestudyofaquadrilateralamputee,overasixteenyearperiod.Exploringcopingwiththechallengesofactivitiesofdailyliving,prostheticinterventionsandadjustingtothepsychologicalimpactofsuchasevereleveloflimbloss.

Presenters: PDavisPrincipleProsthetist,Mr CHurdSeniorOccupationalTherapist,MrsAddress: WestMidlandsRehabilitationCentre91OakTreeLane,SellyOak,Birmingham,B296JA.E-mail: [email protected];[email protected]:Toprovideaholistic,informativeandreflectivecasestudyofayoungquadrilateralamputeewholostallfourlimbsasaresultofmeningococcalsepticaemia,atbilateraltransradiallevelandbilateralthroughknee,aswellassufferingfacialdisfigurement.Thisgivesyouanoverviewofhissixteenyearjourneyuptopresentday.Coveringaspectssuchasmaximising independence inactivitiesofdailyliving,exploringwhataids,adaptationsandprostheticdevicesandinterventionswereinstrumentalinhelping this young man achieve his maximum rehab potential and limitations and obstaclesencounteredalongtheway.MethodsandInterventionsused:Through assessment and reviews focussed on patient goals over this sixteen year period, variousprostheticdevices,bothbody-poweredandmyo-electrichavebeentrialedbypatientwithvaryingdegreesofsuccess.AssessmentsusedtoguidetreatmentplansincludedtheCanadianOccupationalPerformanceModelCOPM,PatientGoalSetting,ULPUGUpperLimbProstheticUsageGuideandUGtimedupandgotestforhislowerlimbprostheses.Aswellasprostheticdevices,variousequipmentaids,housingadaptationsandcaralterationshavebeenassessedforandprovidedtoenabletheatienttoachievehisgoalsandenhancehisindependenceandqualityoflife.Resultsandfindings:He isnowanextremelyadeptprostheticuserofgrieferelectrichandswithwrist rotation. Hehasfoundvariousequipmentaidsinvaluableinprovidinghimwithindependenceinactivitiesofdailyliving.Housing and car alterationshavebeen carriedout tomaximise independenceandachievepatientgoals.Hehashisownworkshopofadaptedtoolstomakevariousappliancesthathesells.Throughpatientassessment,feedback,reviews,photos,videofootageofpatientoverthepastsixteenyearsthispresentationwillshowhowayoungmanhasgraduallyadaptedtothedailychallengesofbeingaquadrilateral amputee. This case study emphasises the importance of family support, patientmotivation and determination, forming a good therapeutic relationshipwith our patients built onhonesty,trialanderrorandthesameendgoal.Conclusionsummary:Inconclusionwehopethatbysharingwithyouthisextraordinaryyoungmansjourneywewillinspireothersaboutwhatcanbeachieveddespitethelossofallfourlimbs,andprovideaninformativeandinterestingoverviewofworkingwithpatientswithsimilarlevelsofdisability.Bygainingabetterunderstandingandvaluableknowledgeofwhathasbeenlearntfromthiscasestudyandhowweashealthprofessionals canassist, guideand supportourpatients inmaximising theirindependence and achieving their goals along the sometimes rocky, challenging journey ofrehabilitation

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Title: Aprotocoltoestablishtherelativeimportanceoffactorsinfluencingeaseofmyoelectricprosthesiscontrol

Presenter: AlixChadwell,PhDstudent,Miss

Address:PO34BrianBlatchfordBuilding,UniversityofSalford,Salford,M66PUE-mail:[email protected]: LPJKenney,Engineer,SThies,Engineer,AJGalpin,Psychologist,JHead,Prosthetist,

UniversityofSalfordAnumberofreportshavesuggestedthatmyoelectricprosthesescanbedifficulttocontrol.Formanythishascontributedtolimitedactiveuse,oreventotalrejectionoftheirprosthesis.Non-usageoftheprosthesiscaninturnleadtooveruseoftheintactlimbandinjuries.Oneofthemajorfactorsassumedtocontributetopoorcontrolistheabsenceofsensoryfeedbackandthishasledengineerstodevoteconsiderableefforttoaddressingthis issue.However,asdemonstratedbySaunders1,amyoelectrichandwhose response isboth fastandhighlypredictable canbeaccurately controlled,even in theabsenceofsensoryfeedback,suggestingotherissuesmaybeequallyormoreimportant.Inthispaperwehavecharacterisedtheoverallproblemofcontrolofcurrentmyoelectricprosthesesasconsistingofaseriesofinter-linkedperson-specificandprosthesis-specificelements.Tounderstandtherelativeimportanceofeachoftheseelements,wehavedevelopedanovelassessmentprotocoltocharacteriseeachofthesubjectandprosthesisspecificelementsintheprosthesiscontrolchain,aswellasprosthesisfunctionalityandpatternsofeverydayuse.Specifically,thefollowingmethodsarepresentedforassessing:1)Userskillingeneratingtherequiredmyoelectric(EMG)signal.Usingsimpletrackingtaskstheabilityoftheusertocontrolthesignalamplitudewillbeassessed.Additionally,anovelreactiontimetestwillprovideameasureofhowintuitiveitisforuserstoactivatethemusclescontrollingtheirprosthesis.2)Unpredictabilityintroducedattheelectrode-skininterface.Aseriesofreactiontimetestswillbeundertaken with a ‘perfect’ electrode skin interface, acting as a control, and with socket-locatedelectrodes(andmechanicalloadsappliedtothesocket)toestablishtheeffectofsocketfitandloadingonvariabilityinprosthesisresponsetimes.3) Electromechanical delayswithin theprosthesis itself. The time taken for theprosthetic hand torespondtoanelectricalsignalattheelectrodewillbemeasured.Functionalitywillbeassessedasfollows.Firstly,usingasimplefunctionalupper-limbtaskthefollowingaspectswillbeassessed:1)Tasksuccessandduration,2)Qualityofmovement(usingaccelerometry,andhandapertureanalysis),and3)Gazebehaviour.Finally,forthefirsttime,theextenttowhichtheparticipantsusetheirprosthesisineverydaylifewillbeassessedbyinvitingparticipantstowearanactivitymonitor(accelerometer-baseddevice)oneachwrist.Metricswillincludetotalprosthesisweartime,aswellasmeasuresreflectingrealworldbilateralarmuse2.Theprotocolisportableand,followingpiloting,willbeusedtocollectdataatanumberofprostheticcentres across England. In order to establish the relative contributionof each input factors to thevariousmeasures of overall functionalitymultiple regressionmodels will be used. Secondary, butequally novel, research questions will also be explored, including the relationship betweenperformanceonfunctionaltasksanduseoftheprosthesisineverydaylife.Theresultsofthisstudywillprovide,forthefirsttime,clearguidancetofutureresearchersonthemostproductiveareastofocuson.1. SaundersIandVijayakumarS.Theroleoffeed-forwardandfeedbackprocessesforclosed-loopprosthesiscontrol.JournalofNeuroEngineeringandRehabilitation.2011;8:60-.2. BaileyRR,KlaesnerJWandLangCE.QuantifyingReal-WorldUpper-LimbActivityinNondisabledAdultsandAdultsWithChronicStroke.NeurorehabilitationandNeuralRepair.2015;29:969-78.

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Title: Choosingamulti-functionalhandthatsuitsthepatient’srequirementsPresenter: JudyDavidson,OccupationalTherapistAddress: P.O.Box1569,BondiJunctionNSWAustralia2022

Telephone: +61293878086Email:[email protected]

Aimofthestudy:Enablingtheamputeetochoosehisownmulti-functionalhandhasbeenaprojectforthelast4years.

Techniques used: In NSW, the insurers need justification of the functional benefits of themultifunctionalhandpriortoitsapproval.Thisisdifficulttobespecificwithouttheindividualamputeehavingtheuseofatrialprosthesis.Since2013thefollowingunilateralupperlimbamputeeshavehadtrialsofoneormorehandspriortoprescription:

• DS(2013and2014)andBW(2014)–IlimbandMichelangelo(BebionicnotavailableinAustraliain2013and2014)

• PT(2015)–IlimbandBebionic(didnotwanttotrialaMichelangeloP• RG(2013and2015)–theIlimbandBebionic• AS(2015)–TrialofBebionicandIlimbbrieflyandSensorspeed.–theconclusionwasAShadonlyaone

sitecontrol.• RH(2016)-TrialofMichelangelo

Thequestionsthatareaskedbyallfundingbodiesforaprostheticrequestare:

• Statetheparticipantcentredgoal/sthatrelatestothis/theseitemsofprosthesis.• Describewhytheparticipantneedsthisprosthesis.Howoftenisthisprosthesislikelytobeused?

• Describewhythefeatures/specificationsoftheproposedprosthesisarereasonableandnecessary.Whyhavethesecomponentsbeenchosen?

• Cantheparticipantdonnanddofftheprosthesisindependently?Ifnotwhatassistanceisrequired?• Otherinformationrelevanttotheprescription.• Whatotherprostheticoptions/componentswereconsideredortrialed?Whyaretheynotappropriate?

Results:Eachtrialcostsabout$5,000ifaninterimsockethastobefabricatedbut$1,000iftheyalreadyhaveasuitablesocket.Everyinsurerhasapprovedtheinterimsocketandtrialofthehand.Theycanseetheirwaytoapprove$5,000withouthighlevelsofjustificationbutthecostof$100,000requiresoversitebytheNSWgoverningbodyandismuchmorestringent).

Asaresult,thepatientsareabletodeterminetheirpreferencebasedonavarietyoffactorsincludingcosmesisandfunction.Appropriatefunctionaljustificationsdealingwithspecifictasksareabletobesubmittedforfundingtoeasilyanswerthequestions.TodateallbutAShavehadthemultifunctionalhandapproved.TheconlusionaftertrainingwasthatAShadasinglesiteandwashavingdifficultycontrollingarigidgriphandandsufficientjustificationcouldbeachievedatthattime. Itmightbeachievedinthefutureafteruseoftherigidgriphand.:

Themethodof prosthetic controlwas identified accurately, the postures thatwere identified, theoutcomefromothertrialsifanotherhandhasbeenused.Theamputeealsotakesresponsibilityfortheirowndecisions.Manufacturersknowthattheyhavetobeabletoloanhandtomakefuturesales.Todatealloftherequestshavebeenapproved.Specifictasksareidentified.Notallresultshavebeensuccessful.

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Title: 3Dprintedupperlimbprostheticsarenotbackedbyclinicalevidence

Presenter: LauraEDiment1,EngineeringDPhilCandidate,Mrs

ContactAddress: BotnarResearchCentre OldRd

OxfordOX37LD

Tel:01865227374Fax:-Email:[email protected]

OtherAuthors: JeroenBergmann1,MarkThompson1

1. MechanobiologyGroup,IntituteofBiomedicalEngineering,UniversityofOxford

Additivemanufacturingprovidesanexcitingopportunitytocreatecustom-madelow-costprostheticarms.Manycommunityprojects,includingtheOpenHandProject,E-NableandOpenBionics,provideopen-source prosthetic designs for printing on consumer printers. However, despite the growingpopularity of open-source 3D printed prosthetics, the clinical efficacy and effectiveness of usingadditivemanufacturingtodevelopupper-limbprostheticshasnotbeenassessed.A systematic reviewof literaturewas performedusing PubMed,Webof Science andOVID to findmanuscriptsthatreportedhumantrialsof3Dprintedupper-limbprosthetics.Thetitleandabstractofeachpublicationwasreviewedtoassesswhetheritmettheinclusioncriteriaof:

I. Relevance-manuscriptswererequiredtoreportonatrialwithhumanparticipantsthattesteda3Dprintedupper-limbprosthetic.

II. Language-onlymanuscriptswrittenortranslatedintoEnglishwereincluded.III. Peer-review-manuscriptswererequiredtohavebeenthroughapeer-reviewprocess.

Only6manuscriptsmettheinclusioncriteria,andthesemanuscriptsdidnotciteanyotherstudiesthatfittedtheinclusioncriteria.Themanuscriptswereratedaccordingtotheirlevelofevidence,usingthestandardclassificationsystemoftheOxfordCentreforEvidenceBasedMedicine(1).All6studiesevaluatedbelow-elbowdevices.Onewasashoulder-controlledandexternallypoweredhandthatwastestedwitha13-year-oldtransradialamputee,anothertestedawrist-flexion-activatedhandwith11childrenwhohadupper-limbreductions.Anelectricprosthetichandwastestedbyanadultamputee,andaforearmexoprosthesiswastestedwithanadultwithearlyflaccidhemiplegiaoftherightarm.Thefinaltwostudiesonlyincludedhealthyparticipants.Onewasasoftfingerpneumaticactuatorthatwastestedby5able-bodiedadultsbyattachingittotheindexfingerofahandorthosis,andtheotherwasamyoelectricprosthesisthatwasvalidatedthroughanable-bodiedresearcherusingittoperformasetofdaily-livingtasks.Toanalysethequalityofthestudiesunderreview,theQualityIndexbyDownsandBlack(2)wasusedtoassessthereporting,externalvalidity,bias,confoundingandpowerofeachmanuscript.Theresultsofthisreviewshowthatveryfewstudiesassesstheefficacyofusingadditivemanufacturingforupper-limbprosthetics, and those thatdoare case studiesorpilot studies that receiveda lowqualityscore.Nopaperspresentedrandomisedorcontrolledtrials,andtherewasnotenoughdatatoperformameta-analysistoassesstheefficacyof3Dprintingforupper-limbprosthetics.However,all6studiesshowedpromisingresults,suggestingthatitisworthcontinuingresearchintotheefficacyofadditivemanufacturingforupper-limbprosthetics.Alarge-scaleclinicalstudyoftheeffectivenessofusing3Dprinteddevicescomparedtodevicescommonlyprescribedbyprosthetistsisrecommendedbefore3Dprintedproductsarewidelypromotedanddistributed.REFERENCES1. OxfordCentreforEvidence-basedMedicine.LevelsofEvidence.UnivOxford[Internet].2009;4–5.Availablefrom:

www.cebm.net2. DownsSH,BlackN.Thefeasibilityofcreatingachecklistfortheassessmentofthemethodologicalqualitybothof

randomisedandnon-randomisedstudiesofhealthcareinterventions.JEpidemiolCommunityHealth.1998;52(6):377–84.

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Title:Utilising3Dprintingtechniqueswhenprovidinguniqueassistivedevices:AcasestudyPresenter:SarahDay,NationalCentreforProsthetics&Orthotics,UniversityofStrathclyde, Glasgow,UKContactDetails: WolfsonCentre TelNo: +44(0)1415484034 106Rottenrow FaxNo: +44(0)1415483295 Glasgow Email: [email protected] G40NW UK OtherAuthors:MrsSarahDay,TeachingFellow,Prosthetist/OrthotistPartial hand amputations can cause limitations in some functional activities. This case studydiscusseshowcomputeraideddesign(CAD)and3Dprintingtechniqueswereutilisedinprovidingasuitableassistivedeviceforapartialhandamputee,tomeethisspecificfunctionalneeds.Thepatientwasa77yearoldmalewithapassionformusic,inparticulartheFrenchhorn,whichheplayed sociallywithagroupof friends. Sinceundergoinga left5th fingeramputationhehadbeenunabletoholdhismusicalinstrumentsecurelyasthe5thdigitofthelefthandisfundamentalinthisaction. This had caused him difficulty in playing and resulted in him giving up this recreationalactivity.Theaimofthisprojectwastodesignandfitadevicewhichwouldenablehimtocomfortablyholdthe musical instrument for prolonged periods, enabling him to play again. An alginate cast of thepatient’shandwas taken,anddimensionsof themusical instrumentwererecorded.ThecastwasscannedusingaphotogrammetrytechniquewithAutodesk123DCatchsoftwaretofinalisethescan,and 3 different assistive device designs were modelled using Autodesk Fusion 360 software. ThedesignswerethenprintedusingaZmorphprinter,andfittedtothepatient.FEAwasperformedonthedesigns,takingintoaccounttheweightofthemusicalinstrumentandforcesappliedthroughit.Fitandfunctionwereassessedwithintheclinic,andfollowingthecompletionofanappropriateriskassessment the patient took the devices for home trial. The patient completed a simplequestionnaire after using each device which covered topics such as fitting, comfort, function andcosmesis.The3Dprinteddeviceswerealsocomparedwithalowtemperaturethermoplasticdeviceandafabricdevicewhichhehadpreviouslybeensuppliedwith.It took an average of 3 hours to design each device, although this would reduce as experience ofusingthesoftwareincreases,andprintingtimeaveraged5hours.Theaveragecostofprintingeachdevicewas£13.37.Benefits of using CAD and 3D printing techniques when fabricating one-off functional devices arethat the low cost and low fabrication time, alongside ease of repeatability make it economical toremake devices after small design modifications, thus improving the quality of the device beingprovided.

35

Title: ApplicationofFinch,a3Dprintedprosthetichand,toapatientwithbilateralupper-limbdeficiency

Presenter: SatokoNoguchi,OccupationalTherapist

Address: 7-3-1Hongo,Bunkyo-ku,Tokyo,Japan,113-9655Tel: +81358008795


OtherAuthors: SayakaFujiwara,MD,PhD,TheUniversityofTokyoHospital

TerukiShibata,CPO,TazawaMFGCo.,Prosthetic&Orthotics

MasahiroYoshikawa,Engineer,OsakaInstituteofTechnology

NobuhikoHaga,MD,PhD,TheUniversityofTokyoHospital

Thepurposeofthisstudyistodemonstratefittingandeffectivenessofa3Dprintedprosthesis,Finch,forpatientswithbilateralcongenitalupper-limbdeficiency.Finchwasdesignedasatrans-radialprosthesiswithsimplemechanism,controllingthreedigitstocontributetoitsgoodworkability,lightweight,andlow-cost.

Here we report a 5-year-old boy with congenital deficiency of bilateral whole upper-limb, early-onsetidiopathic scoliosis, and mild mental retardation. As he was wearing a spinal orthosis for his idiopathicscoliosis,thespinalorthosiswasremodeledtoconnecttheshouldersocketsforbilateralprostheticarms.Afterhisadaptationtotheweightandbodyimagewithbilateralprostheticworkarms,Finchwasconnectedtotherightarmprosthesis.Adistancesensorwasplacedattheinnersideofthespinalorthosistooperatethe Finch system. Through this process, he could press the sensor with his left shoulder voluntarily, andcontrolFinchwelltoholdhisfavoritedollandplaysimplegamesbyhimself.

ThesefindingssuggestthatFinchisausefulandpracticalelectricprosthesiswithlowexpenseforpatientswithbilateralupper-limbdeficiency.Finchconnotesapotentialtoincreasethepossibilityofchildrenwithupper-limbdeficiencybyprovidingtheopportunityofchallengingandparticipatinginvariousactivities.Onthe other hand, as 3D printed parts used in Finch are not strong enough for daily use, this trial may beconfinedtolimitedsettingsinoccupationaltherapyandathome.

36

Manufacturers’WorkshopsFourworkshopswillrunconcurrently,withcontributionsfromTouchBionics,Steeper,OttobockandFillauer.Placesarelimitedandwillbeticketed.Delegateswhohavenotalreadyregisteredforworkshops,shouldvisittheISPORegistrationDeskby12noononWednesday28thSeptember.

IntroducingtheSuproWrist-TouchBionics

thenewelectronicwristrotatorfromTouchBionicsisthefirsthandandwristprosthesiswithsynchronizedwristrotationandgripselection.Usingi-mo™technology,whenani-limb™quantumgripisactivatedusinggesture control, the supro wrist will simultaneously choose the correct wrist orientation. Separately, arotational control can be activated via digital electrodes using intuitive ‘rotate-left’ and ‘rotate-right’proprioceptivesignals.Theworkshopwillintroducethesefunctionsandthebenefitstotheprostheticuser.

bebionicProstheticDevelopment–Steeper

Steeperwilldiscussthedevelopmentsindesign,technologies,performanceandcontrolstrategiesbehindthecompleterangeofbebionicmulti-articulatinghands.This interactiveworkshopwillprovidedelegateswiththeopportunitytoaskdetailedquestionsaboutthetechnologyofthebebionicrange,andtheimpactofthesefeaturesuponbebionicusersandtheirdailytasks.TheworkshopwillberunbyTedVarley,SteeperTechnicalDirectorandBrianMcLaughlin,SteeperProductManager.

Fittingsolutionsforchildren–Ottobock(SessionA)BodyPoweredEducationConcept:TryBodyPoweredKit–Ottobock(SessionB)

TheOttobockworkshopswillbepresentedbyErikAndresandDieterStorkandwillbeinteractivesessionsusingdemonstrationproductsandofferingcontentincludingcasestudies,fittingsolutionsandanewtherapyconceptforparentsofchildrenwithupperlimbamputations/deficienci

UpperLimbProductLine:Rugged,PracticalandElegant-FillauerTRSNewProducts-presenter:BobRadocy

TRScontinuestopursuethedevelopmentofbody-poweredandactivity-specificUEprostheticproductsthatprovide theprofessionwithoptions.Options thatprovide theprostheticprofessionalwith the tools theyrequiretocreatemoreversatileandfunctionalsolutionsfortheirpatients/customers.Wewillbepresentingsomeofourmostinnovativeandnewproductconceptsaswellasdiscussingfutureproductdevelopment.TRSPROCUFFprosthesesandProstheticSimulatorswillbedemonstratedalongwithnewtechnologythatsimplifies and enhances the prosthetist’s ability to create better products for individuals with a wristdisarticulationorpartialhandabsence.OurnewestvoluntaryclosingprehensortheGRIP5Evolutionwillbedemonstrated.TheGRIP5 isour first step inenhancingprostheticTDdesignwith21stCenturygraphics.Additionallywewillpresentareviewofthewidevarietyofactivityspecificprostheticadaptersthatarenowavailableprovidinghighperformanceaccess toactivities fromswimming toweight liftingandhowmanyproductshave“cross-over”vocationalanddomesticapplicationsmakingiteasiertojustifytheirprescriptionandacquisition.

TheNewestinMotionControl(MC)ElectricTerminalDevices–presentersScottHosieandHaroldSears

LearnabouttheruggednessandconvenienceinMotionControldevices.Featuringhands-ondemonstrationoftheset-upandutilizationforboththepractitionerandthepatient:

• Bluetoothadjustment,viathefreeApp,MCUI,foriPhoneandiPad.• Auto-Cal,allowingthewearertotriggeranautomaticre-calibrationwhenevertheyarefatigued.• FLAG–(ForceLimitingAuto-Grasp).Dependablepatient-friendlyforcecontrol.Holdababy’s

hand,orholdafinecamera–you’reincontrol.• ProWrist–thefinestwristcontrol,connecttoBluetoothforperfectadjustment.• NEW–ETD2,thenewestversionofthehighlyruggedETD,withhigheraesthetics.• PoweredFlexionWrist–comingsoon.CompatiblewithmodifiedMCsystems,aswellasother

manufacturers’hands.

Manufacturers’WorkshopsFourworkshopswillrunconcurrently,withcontributionsfromTouchBionics,Steeper,OttobockandFillauer.Placesarelimitedandwillbeticketed.Delegateswhohavenotalreadyregisteredforworkshops,shouldvisittheISPORegistrationDeskby12noononWednesday28thSeptember.

IntroducingtheSuproWrist-TouchBionics

thenewelectronicwristrotatorfromTouchBionicsisthefirsthandandwristprosthesiswithsynchronizedwristrotationandgripselection.Usingi-mo™technology,whenani-limb™quantumgripisactivatedusinggesture control, the supro wrist will simultaneously choose the correct wrist orientation. Separately, arotational control can be activated via digital electrodes using intuitive ‘rotate-left’ and ‘rotate-right’proprioceptivesignals.Theworkshopwillintroducethesefunctionsandthebenefitstotheprostheticuser.

bebionicProstheticDevelopment–Steeper

Steeperwilldiscussthedevelopmentsindesign,technologies,performanceandcontrolstrategiesbehindthecompleterangeofbebionicmulti-articulatinghands.This interactiveworkshopwillprovidedelegateswiththeopportunitytoaskdetailedquestionsaboutthetechnologyofthebebionicrange,andtheimpactofthesefeaturesuponbebionicusersandtheirdailytasks.TheworkshopwillberunbyTedVarley,SteeperTechnicalDirectorandBrianMcLaughlin,SteeperProductManager.

Fittingsolutionsforchildren–Ottobock(SessionA)BodyPoweredEducationConcept:TryBodyPoweredKit–Ottobock(SessionB)

TheOttobockworkshopswillbepresentedbyErikAndresandDieterStorkandwillbeinteractivesessionsusingdemonstrationproductsandofferingcontentincludingcasestudies,fittingsolutionsandanewtherapyconceptforparentsofchildrenwithupperlimbamputations/deficienci

UpperLimbProductLine:Rugged,PracticalandElegant-FillauerTRSNewProducts-presenter:BobRadocy

TRScontinuestopursuethedevelopmentofbody-poweredandactivity-specificUEprostheticproductsthatprovide theprofessionwithoptions.Options thatprovide theprostheticprofessionalwith the tools theyrequiretocreatemoreversatileandfunctionalsolutionsfortheirpatients/customers.Wewillbepresentingsomeofourmostinnovativeandnewproductconceptsaswellasdiscussingfutureproductdevelopment.TRSPROCUFFprosthesesandProstheticSimulatorswillbedemonstratedalongwithnewtechnologythatsimplifies and enhances the prosthetist’s ability to create better products for individuals with a wristdisarticulationorpartialhandabsence.OurnewestvoluntaryclosingprehensortheGRIP5Evolutionwillbedemonstrated.TheGRIP5 isour first step inenhancingprostheticTDdesignwith21stCenturygraphics.Additionallywewillpresentareviewofthewidevarietyofactivityspecificprostheticadaptersthatarenowavailableprovidinghighperformanceaccess toactivities fromswimming toweight liftingandhowmanyproductshave“cross-over”vocationalanddomesticapplicationsmakingiteasiertojustifytheirprescriptionandacquisition.

TheNewestinMotionControl(MC)ElectricTerminalDevices–presentersScottHosieandHaroldSears

LearnabouttheruggednessandconvenienceinMotionControldevices.Featuringhands-ondemonstrationoftheset-upandutilizationforboththepractitionerandthepatient:

• Bluetoothadjustment,viathefreeApp,MCUI,foriPhoneandiPad.• Auto-Cal,allowingthewearertotriggeranautomaticre-calibrationwhenevertheyarefatigued.• FLAG–(ForceLimitingAuto-Grasp).Dependablepatient-friendlyforcecontrol.Holdababy’s

hand,orholdafinecamera–you’reincontrol.• ProWrist–thefinestwristcontrol,connecttoBluetoothforperfectadjustment.• NEW–ETD2,thenewestversionofthehighlyruggedETD,withhigheraesthetics.• PoweredFlexionWrist–comingsoon.CompatiblewithmodifiedMCsystems,aswellasother

manufacturers’hands.

37

ABSTRACTS-Thursday29September(inorderofpresentation)

Title: Advancesinprosthesiscontrol–gesturecontrol

Presenter: AlisonGoodwin,Prosthetist,Miss

Address: TouchBionics,Unit3AshwoodCourt OakbankParkWayLivingston,UK

EH3OTHE-mail: [email protected]: LewisMackay,OccupationalTherapist,Mr,TouchBionics-Livingston

Developments in the functions ofmulti articulating hands have advanced dramatically in the lastdecade.Allowingprosthetichandstomorecloselymimicthefunctionsofahumanhand,andenablingtheusertoperformactivitiesinamoreprecise,naturalway.Althoughthefunctionalityhasincreasedthemethodsofcontrolhaveremainedunchanged.

Theuseoftraditionalmyoelectriccontrolhaslimitedthedirectaccesstotheseadvancedfunctions,referredtoasthebandwidthissueofprosthesiscontrol.

Currentmethodsofswitching functions includespecificmusclesignals,hardwareswitches,mobileapplicationcontrol,andBluetooth.Thesemethodshaveofferedapracticalsolution,howevereachhaslimitations.Forexample:increasedrequirementforadvancedtraining,useofcontralateralhand,necessityforadditionalaccessories.

Acknowledgement of these limitations has led to the development of a more accessible controlmechanism which aims to reduce this perceived complexity. Gesture control utilises physicalmovementsoftheprosthesistoinstructthehandonwhichgrippatterntoadopt.

Benefitsofgesturecontrolinclude;noadditionalaccessories,nouseofthecontralateralside,quickerandeasiertolearn,learningonlyonetechniqueoffersaccesstofourfunctionsofthehand.

As gesture control is easier and quicker to learn the clinician can focus more time on practicalapplicationsofthefunctions,ratherthanonadvancedtrainingonhowtoaccessthefunctions.

Gesturecontrolhelpstoclosethegapbetweenthetechnicaldevelopmentsandtheusers’abilitytoaccessandusethesefunctionspracticallyintheirdailylives.

38

Title: Structuredtrainingforadvancedprosthesiscontrol

Presenter: SebastianAmsüss,R&DEngineer,PhD

ContactAddress: OttobockHealthcareProductsGmbH Tel:+43-1-5233786-343

Brehmstraße16 Fax:+43-1-5267985

Vienna,Austria E-mail:[email protected]

1110

OtherAuthors:

IvanVujaklija,PhDStudent,InstituteofNeurorehabilitationSystems,UniversityMedicalCenterGöttingen

ChristianHofer,ClinicalResearchCoordinator,OttobockHealthcareProductsGmbH

TimothyHasenöhrl,ResearchScientist,DepartmentofPhysicalandRehabilitationMedicine,MedicalUniversityofVienna,Vienna

AidanRoche,CoreSurgicalTrainee,DepartmentofPlasticSurgery,NorthBristolNHSTrust

DarioFarina,Director,InstituteofNeurorehabilitationSystems,UniversityMedicalCenterGöttingen

OskarAszmann,Director,CenterforExtremityReconstructionandRehabilitation,Plastic&ReconstructiveSurgery,MedicalUniversityofVienna

Aimsandobjectives

Theaimofthisstudywastoinvestigatetheefficacyofstructuredtrainingofnaïvesubjects,whoforthefirsttimeexperiencedadvancedcontrolofamulti-articulatedprosthesisoftheupperextremity.

Methods

Tensubjects(9male,1female)withacquiredunilateraltransradialamputationparticipatedinthisstudy.Eachamputeehadbeenwearingamyoelectricprosthesisforatleast1.5years,4hoursperday.A certified prosthetist manufactured experimental prosthetic systems with an active wristflexion/extensionjoint,activerotationunit,eightsurfaceEMGelectrodesandaMichelangelohandprosthesis (all from Ottobock Healthcare Products, Vienna, Austria) for each participant.Simultaneous, proportional activation of the wrist flexor and rotation units (linear regression)combined with sequential, proportional hand function (linear discriminant analysis classifier) wasimplemented1.

Subjectswere randomlydivided in2groupsandcompleted3sessionseach,withaminimumof3weeksbetweensessions.Usersdidnothaveaccess to theadvancedprosthesisbetweensessions.First,areferenceSHAP2testwiththeprosthesisofdailyuse(“baseline”)wasperformed.Inthesecondsession, after sufficient familiarization, each subject completed a SHAP test with the advancedprosthesiswithoutanyspecificusertraining(“naïvesession”).Inthethirdsession(“followup”),thefirstgroupagaincompletedSHAPwithoutuser trainingand the secondgroup receivedstructuredtrainingtomaximizecontrolbenefitfromtheadvancedprosthesisbeforecompletingthetest.

Thestructuredtrainingcomprisedthefollowingstages:

1) Imitationstage:Userfollowsexperimenter’smovementswithphantomlimb2) Repetitionstage:Userrepeatsthemovementsonhisown3) Biofeedback stage: User is presented with visualization of exerted muscle signals and is

instructedtomakethemmoreconsistentusingtheshownbiofeedback

39

4) Adaptationstage (onlyapplied ifnecessary):Experimenterpromptsuser toslightlymodifyphantommovementsforbetterdifferentiabilitywhileusingbiofeedback(“Usefingers4and5morewhenpinching”,“Don’textendwristwhilerotating”…)

Theeffectofthisstructuredtrainingonuserperformancewasexaminedusingclinicalmeasures.

Results

Allsubjectscompletedthefullexperiment.Averagebaselinescoreswere63.4±7.3and66.6±10.1forsubjects in non-training and training group, respectively. With the advanced prosthesis, averagescoresinthenone-traininggroupwere38.4±8.9inthenaïveand41.2±10.2inthefollowupsession(+2.8±8.6).Subjectsthatreceivedtrainingimprovedfrom27.8±11.4inthenaïvesessionto49.0±11.6infollow-upsession(+21.2±8.3).

Conclusions

Although the subjects in the training group performed considerably worse with the advancedprosthesis in the naïve session compared to the non-training group, they outperformed the non-traininggroupnotablyinthefollow-upsession.ThelattergroupshowedonlyminorchangesinSHAPscores. Subjects of both groups performed similarly with their own prosthesis and all subjectsperformedbestwiththeirclinicalprosthesisofdailyuse.

Weconcludethatthestructuredtrainingapproachfollowedinthisstudyhasanimportantinfluenceontheoutcomeofusabilitywhenusingadvancedprostheticcontrolstrategies.Longtermtrainingappearstobewarrantedforprofoundfamiliarization.

References

1. AmsuessS,VujaklijaI,GobelP,etal.Context-DependentUpperLimbProsthesisControlforNaturalandRobustUse.IEEETransNeuralSystRehabilEng.2015:1-1.

2. LightCM,ChappellPH,KyberdPJ.EstablishingaStandardizedClinicalAssessmentToolofPathologicandProstheticHandFunction:NormativeData,Reliability,andValidity.ArchPhysMedRehabil.2002;83(6):776-783.

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Title: Upperlimbosseointegration,prosthetictechnology.

Presenter: SteweJönssonCPO

Address: TeamOlmed Tel:+46(0)706-404224 Tölövägen9 E-mail:[email protected] 43480Kungsbacka SwedenOrthopaedicosseointegration(OI)forfixationofextremityprosthesishasbeenongoingforover26yearsandgainsmoreandmoreground.Forus,whohasbeeninvolvedinthisfieldovertheyears,thetreatmentistodayapartofourdailyactivities.Butforcolleaguesthatarenewinthisfield,thereisaneedofknowledgeandtraining.Upperlimbosseointegrationfromaprosthetic,rehabilitationandaprosthetistpointofviewhasbeendescribed(1,2).Thispresentationwillfocusonnewtechniques,giveaguidelineintothecomponentsystemsandliftupsomeFAQabouthandlingandconstructions.Improvementoftheprostheticfittingprocedure,includingquickandeffectiveprostheticfittingclosetotheS2surgeryisimportant.ForTHlevelthepatientcanhaveasafeandcontrolledsituationduringtheinitialweighttrainingphasebyusingaspecialfulllengthprosthesis,withabuiltinweightsystem.Diagnostic/checkoutprosthesisfordirecttemporaryfittinganddatacollectioncanbeused.Withthisprosthesis,EMGsites,functions,alignmentsandlengthcanbetriedoutdirectlyandbeforethefinalprosthesisisfabricated.Onlyonepatientvisitbeforedeliveryofthefinalprosthesisisneeded.Forallexisting amputation levels the prosthetic production methods also makes it possible to replicatemethods,facilitatesforcentral/distancefabrication.

Component sets for OI prosthetics is available and cover most needed parts. Those are used incombinationswithordinaryULprostheticcomponents,howeversomerecommendationsexist.Thereisstillaneedofsomecustommadecomponents,suchasspacers,theattachment“puck”forTRlevelandelectrodeholders.Forfingerlevelsthecomponentkitcanbeusedincombinationwithseveralproductionmethodsofthesiliconecosmeticcoverandfillers.

OI prosthetics shall alsomeet up and take advantages of new platforms, for example, implantedelectrodesforsignalpickupsandsensoryfeedbacksystems.

References:1. S.Jönsson,K.Caine-Winterberger,R.Brånemark,“Osseointegrationamputationprosthesis

ontheupperlimbs:Methods,ProstheticsandRehabilitation.”ProstheticandOrthoticInternational,2011,Vol35(2)190-200.sagepub.co.uk/journalsPermissions.nav.DOI:10.1177/0309364611409003

2. ExtendedabstractMEC,SteweJönsson.“Osseointegrationonupperlimbamputee.Prosthetictreatment.”http://dukespace.lib.duke.edu/dspace/bitstream/handle/10161/4751/67%20Jonsson.pdf?sequence=1

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Title: ClinicalPatternRecognitionintheUS:ExperiencesandDemographicsPresenter: BlairALock,ManagingPartner,MrContactAddress: CoaptLLC 222WOntarioSt.,Suite300 Chicago,IL(USA) 60654Tel: 844-262-7800Fax: 844-262-7800E-mail: [email protected]: FrankCummins,R&DEngineer,CoaptLLC

AimeeFeuser,ResearchEngineer,CoaptLLCPattern recognition for improved control of powered upper limb prosthetics has been a focus ofresearchanddevelopment fordecadesatmany institutionsaroundtheworld.Resulting fromthateffort,arobustpatternrecognitionsolutionwasmadecommerciallyavailableintheUSin2014andhas been quickly gaining in popularity. To date, a significant number of these systems have beendeployed to users of various amputation levels and applied to many different configurations ofprostheticcomponents.Responsesfromusersandclinicianshavebeenhighlyfavorable,withmanyusersreportingthatthenewsystemallowsthemunprecedentedcontroloftheirdevice.In this paper, we present a comprehensive look into the breakdown of pattern recognitiondeploymentbyamputationlevelandclinical involvement.Also includedisspecificattentiontotheapplications for unique subsets such as targeted muscle reinnervated, congenital, and bilateralamputeeusers.Collectedqualitativeassessmentfrompatients,practitioners,therapists,andotherstakeholderswillalsobeshared.Thisclinicalsummaryisafirst-of-its-kindreportofalargenumberofpattern recognition users and the only to date showcasing pattern recognition as a commerciallyavailablesystem.

42

Title: Clinicalexperienceofdevelopingbespokecyclingprostheses

Presenters: BrianBradbury,ProstheticTechnician

PaulRichardson,HCPCRegisteredProsthetist

Address: PaceRehabilitation

36BrookStreet

Cheadle

Cheshire

SK82BX

Email: [email protected]

Since 2012 Pace Rehabilitation has increasingly been involved with the production of bespokeprosthesis for professional cyclists. We have now gained considerable experience in developingspecialised upper limb prostheses for training and competitive use across several disciplines.Weanticipatethatseveralofthesedeviceswillbeused inRioduringthe2016ParalympicGames.Wereporthereonourapproachtotheseprostheses,muchofwhichcanbeappliedtotheproductionofsimilardevicesforrecreationalcyclists.Keyconsiderationsinourapproach:

• Multidisciplinaryapproachiscritical.Ourteamtypicallyincludesthecyclist,prosthetist,technician,coach,biketechandphysiotherapist….

• Understandingindividualrequirementsfortheparticularevent,including:o Clinical:elbowandshoulderROMs,postureoncycleo Technical:connectionpointtocycle,positions,transitions,

• Equipmentrequiredinclinic:Turbotrainer,rollers,fulllengthmirror,camera• Prosthetichardware:“terminaldevices”andhandlebarmodifications• Trialdevices,feedbackformvarioussources,iterationsofdevice• Manufacturingtechniquesandmaterials,aerodynamicconsiderations• Riskassessmentandsafetyconsiderations• Costs:largetimeinvestmentsrequiredbutgenerallylowhardwareexpenditure

43

Title: EvolutionofanAestheticHeavy-DutyElectricTerminalDevice

Presenter: HaroldH.Sears,PhDBE

Address: MotionControl,div.ofFillauer,115N.WrightBros.Dr.,SLC,UT84116

Tel: (801)326-3434

Fax: (801)978-0848


OtherAuthors: Iversen,EK–MSME;Jacobs,AT-BSME;Christenson,JD–MSME;Myers,MJ-BSME;Biggers,KB-MSBE,Walsh,NJ-BSCS

(allaffiliatedwithMotionControl)

Aimsandobjectives:

Over the lastdecade, theheavy-dutyElectricTerminalDevice (ETD)producthasbeensuccessfullyusedbythousandsofUEamputees.Itssuccessisduetothecombinationoffunctionalhookswithamotordriven2-speedtransmissioninawater-resistanthousing.

Anewversionwassought,withgoalsto,1)shortentheoveralllength(forequivalentlengthbetweeninterchangeablehandandworkTDs),2)useearlierworkwithTDdesignsto improvegripsecurity,and, 3) improve aesthetics so that wearers could use a heavy-duty TD in a wider range ofenvironmentsandsocialsituations.

Methodsused:

Thedevelopmentprocessevolvedanewdevice,theETD2,whichusesadvancedintegratedmetalandplasticmanufacturingmethods. Amoreintegratedaestheticwassought,whileretainingnearlyallpositive features of the earlier ETD, including high durability, water and dirt resistance, lowcomparativeweight,quickspeed,highpinchforce,visibilityandaccessibilityofslenderfingersforfineworkandreachingtightspaces.

The electronic features maintained from the ETD were: “plug and play” compatibility forinterchangeabilitywith almost all other terminaldevices,Bluetoothwireless communicationusingApple handheld devices, and the useful Force Limiting Auto Grasp (FLAG), an electronic methodenablingthewearertolimitpinchforcewhenhandlingfragileobjects.

Summaryofresults

Figure1:ETD2prototype

ThemaintargetshavebeenachievedintheETD2design:overalllengthoftheETD2vs.ETD1is30mmless,equivalentweight;strengthandspeedhavebeenmeasured.Theearlierstandardforwateranddirt resistance ismet, and amethod to allow replacement of the gripping surfaces in the field issuccessfulaswell–amajorimprovement.

44

Asmall-scalefieldtrial(n=6)indicatesequivalentfunctioninmostareas,whilesomegripmodesaresuperior (flat and cylindrical objects), and subjective opinions show aesthetics have improved.Interestingly, for some the reduced length produces a slightly lighter perceived weight. Field-replaceablegrippingsurfacesgeneratepositivefeedbackaswell.

Ongoing surveyofwearerswith the FLAG feature, inbothETDandHands (n=8), shows the ForceLimitingfeaturehighlyrated:7/8respondedpositivelyto“increasednumberoftasksperformed”,andthesameproportionto“abenefitisprovidedintheprosthesisthatIdidnothavepreviously”.

Conclusionsorrecommendationsorimplicationsarisingoutofthiswork

ETD2retainstheearlierfeatures,suchasruggedfunction,highspeedandpinchforce,andintegrationoftheFLAGfeature.Inaddition,fieldtrialsconfirmthebenefitsofloweroveralllength,improvedaesthetics,andstrengthachievedthroughadvancedmanufacturingprocesses.

MoreresultsfromalargerpopulationwillbepossiblewithreleaseoftheETD2deviceaftermid-year2016.

ReferencesIversenE,SearsH,etal.ForceLimitingAutoGrasp(FLAG),AUser-InitiatedMethodforGripSecurityAAOPAnnualAssembly.2015

Sears HH, Evaluation and Development of a New Hook-Type Terminal Device PhD Dissertation,UniversityofUtah.1983

45

Title: PhantomPainRevisited

Presenter: TamarMakin,AssociateProfessor,FMRIBCentre,NuffieldDepartmentofClinical Neuroscience,UniversityofOxford,Oxford,UK


Followingarm-amputationbrainareasthatpreviouslyoperatedthehandwillbe“recruited”toworkforotherbodyparts.Thisabilitytodynamicallyreassignprocessingresponsibilitiestoacertainbrainareabasedonchangingcircumstances(termed‘plasticity’)iskeyforourbasicabilitytoadapttonewsituations.Inamputees,thisprocessiswidelyheldtoresultintheexperienceofphantomlimbpain(pain that is perceived to be arising from the missing hand), and is therefore considered to bemaladaptive.

Evidencewillbepresentedtochallengetheproposedlinkbetweenphantompainandbrainplasticity,andinsteaddemonstratethatplasticityinamputeescanbeadaptive.Itwillbedemonstratedthatdespite amputation, representation of the missing hand is preserved in the human brain. Thismaintained representation of the phantom hand is linked with phantom pain, with potentialimplicationsonfuturetreatment. Itwill furtherbeshownthatcontrarytotextbookwisdom,brainplasticityisnotpre-determined,andisinsteadshapedbyhabitualstrategiesthatindividualsadopttocompensatefortheirdisability;the“freedup”corticalresourcesofthemissinghandcanbeusedbyamultitudeofbodyparts,andevenartificiallimbs.

Basedonthisevidence,itissuggestedthatplasticityinamputeesisexperience-dependant,andisnotinherentlymaladaptive.

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Title: Investigationsoftheuncannyvalleyforprosthetichands

Presenter: EllenPoliakoff,CognitiveNeuroscientist,Dr

Address: UniversityofManchester,Manchester,M139PL

Tel: 01612757333


OtherAuthors: MsSophieO’Kane,Psychologystudent,UniversityofManchester

MsOliviaCarefoot,Psychologystudent,UniversityofManchester

ProfPeterKyberd,ChairofRehabilitationCyberneticsandHeadofDepartmentofEngineeringScience,UniversityofGreenwich

DrEmmaGown,CognitiveNeuroscientist,UniversityofManchester

In1970,Morihypothesisedtheexistenceofan‘uncannyvalley’,wherebystimulifallingshortofbeingfully human are found to be creepy or eerie. Previously we demonstrated thatmore human-likeartificialhandsareratedasmoreeeriethanclearlymechanicalorrealhands.1Inthecurrentseriesofexperiments,wecomparedresponsestophotographsofprosthetichandspre-selectedasmoreorlesshuman-like(‘havinghumanformorattributes’),aswellasmechanicalandrealhands.

Inexperiment1,participants(N=40)ratedthehandsforeeriness(‘mysterious,strange,orunexpectedastosendachillupthespine’)onascaleof0-9,presentedeitherinafirstpersonorthirdpersonorientation.Thelessrealisticprosthetichandswereratedasmoreeerie(mean=6.59)thanthemorerealisticprosthetichands(4.90),themechanicalhands(4.49)andtherealhands(1.23).Inaddition,theorientationofthehands(firstvs.thirdperson)didnotsignificantlyaffecttheratings.Thus,thenotionofanuncannyvalley(orpeakofeeriness)wassupportedforthelessrealisticprosthetichands.However,themorerealisticprosthetichandswerenotuniformlyfoundtobeeerie;theratingsvariedmorebetweenindividualsthanfortheothercategories.

Inexperiment2,participants(N=40)performedaspeededclassification(human/non-human)taskforthesamesetofhands.Reactiontimes(ms)weresignificantlyslowerforthemorerealisticprosthetichands(mean=771)comparedtothelessrealisticprosthetichands(677)andtherealhands(675).This shows that themore realistic prosthetic handswere hardest to characterise,whichwas alsoreflected in thehigherror rate (72%), i.e.mistaking themforhumanhands.Thus, thecategoryofhandsfoundtobemosteerie (lessrealisticprosthetichands)wasnotthesamecategorythatwasmost difficult to categorise (more realistic hands). A control experiment in which participantsrespondedtothelocation(left/right)ofthehandonthecomputerscreenindicatedthattheresultscouldnotbeattributedtoslowerresponsesingeneraltothemorerealisticprosthetichands.

Overall,peopledoreportprosthetichandstobeeerie.Thiseffectwasmostconsistentforlesshuman-likeprosthetichandsanddoesnotseemtobedrivensolelybyambiguityaboutwhethertheprosthetichandfallsintoahumanornon-humancategory.Inaddition,thevariabilityinratingsgiventothemorerealistic prosthetic hands suggests that individual differences in responses to prosthetic hands,includingfamiliarity,wouldbeafruitfulavenuetoinvestigate.Theimplicationsarethatlessrealisticprosthetichandswhicharemoreobviouslyartificialconsistentlygenerateasenseofeeriness,whilemorerealisticprosthetichandsmayavoidtheuncannyvalley,atleastoninitialviewingduetobeingmistakenforrealhands.

1. PoliakoffE,BeachN,BestR,HowardT,GowenE.Canlookingatahandmakeyourskincrawl?Peeringintotheuncannyvalleyforhands.Perception2013;42:998–1000.

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Title: Exploringeverydaymaterialsandprosthetichands

Presenter: GrahamPullin,DesignResearcher,Dr

Address: DJCADUniversityofDundee Telephone:01382386531 PerthRoad Dundee Email:[email protected] DD14HT

OtherAuthors: DrAndrewCook,DesignResearcher,DJCAD DrSarahWilkes,MaterialsScienceResearcher,UCL Prof.MarkMiodownik,MaterialsScienceResearcher,UCL

AndrewTibbles,DigitalPrototyper,MAKLabRichardClifford,ExecutiveDirector,MAKLab

AimsHands of X is exploring the meaning of materials––and the meaning of being able to choosematerials––withamputees,designers,makersandprosthetists.The‘X’standsforofwhatahandismadeandalsoforwhom.The materials currently employed in prosthetics and the reasons for their selection are polarised:silicone, chosen for its mimicry of human skin; carbon fibre for its technical properties; customfabrications for theiroutright individuality.HandsofXexploresanoverlookedmiddleground:ourvisionisanunderstatedcommondesignofferedwithanuancedpersonalchoiceofmaterials.MethodsInthisendeavourweareexploitingandpushingflexibledigitalfabrication.Butwhilst3Dprintingisincreasinglyseenasanimportanttechnologyinthefutureofprosthetics,wewishtochallengetheassumption that this implies a future of plastic hands. In past centuries a much wider palette ofmaterials was drawn on––leathers, woods, metals, fabrics. This use of materials found in othereverydayobjects tiedthedesignofprosthetichandstothedesignofotherthings, lendingthemafamiliarityandapproachability.Ourmethodsinvolvelotsofmaking,sincewebelievethatmaterialitymustbeseenandtouchedtobediscussed.Weareparticularlyinterestedineverydaymaterials,includingdifferentwoods(beech;cedar; ash), plastics (cellulose actetate) and fabrics (felted wool) and in the first instance we aremakinghands––abstractedhands––outofsinglematerialstounderstandhowmaterialalonemightchangepeople’sperceptionsofprosthetichands.IndicationofresultsTIPS 2016 comes 7 months into our 18 month study. We will present the results of participatoryworkshopswithamputees,designers,makersandprosthetists.TheprojectpartnersareDJCAD,theart collegeat theheartof theUniversityofDundee; the InstituteofMakingatUniversityCollege,London;andMAKLab,publicaccessdigitalfabricationcentresacrossScotland.Evenmoreimportantisourcollaborationwithamputees,throughFindingYourFeetandothergroups;limbmanufacturersSteepers;andthelimbfittingcentreatRNOHStanmore.

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Wewillhavebeencollectingsamplesofmaterialsthatpeoplewouldbeinterestedtoseeemployedin prosthetics together with the reasons why. One of the outputs of the workshops will be co-created concepts for hands that combine two materials, which we will prototype. We will alsooutlineourongoingwork toprototypemore representationalprosthesesbasedon thesematerialcombinationsandalsotoprototypetheexperienceofaservicethatcouldoffersuchvariationandchoice.ImplicationsThisprojectisbeingfundednotasmedicalresearchbutaspartof‘DesigntheFuture’,anEPSRCinitiativetoexploreandprototypenewmanufacturingpractices.So for once disability-related design is not (just) benefitting from a ‘trickle down’ effect––ratherprostheticsbeing seenasa crucible forwider innovationacrossmanufacturingasawhole.Whichfeelsanexcitingandappropriaterelationship,givenitsprofundity.ReferencesPullinG.Designmeetsdisability.Cambridge,MA:TheMITPress,2009.MiodownikM.Stuffmatters.London:Penguin,2013.

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CaseStudiesTwocasestudysessions,organizedbySarahDay,willrunconcurrently,eachfor30minutes.Delegateswillhavetheopportunitytoattendbothsessions.

Thesessionswillprovideanopportunityforgroupdiscussionaboutasmallselectionofpatientswithupper limbamputation, thedifficulties theyencounter, challenges theyhaveovercome, treatmentoptionsandfuturedevelopments.Thesessionswillbeinformalandinterprofessionalinnature.

Wewillfocusontwopatientgroups:multiplelimbabsenceandhighlevelamputation,andwillbejoinedbythreevolunteerswhohopetosharetheirstories,challengesandachievementswithus.

Ourvolunteers

Marieunderwentlifesavingbilateraltransradialamputationsin2013followingaviolentinfection.Shemaintainsanactivelifestyledespitehavingextensivescarringtoherresiduallimbs.

Corrineisamotherandbusinesswomanwho,inJune2013,hadherhandsandfeetamputatedaftercontractingsepticaemia.SinceheramputationsCorrinehasundertakenarangeofphysicalchallengesincludingclimbingBenNevis,theUK’shighestmountain.Sheworkstirelesslyforhercharity‘FindingYourFeet’–http://findingyourfeet.netwhichprovidespractical,emotionalandfinancialsupportforthosewhohavesufferedlimbloss.Corrineiscurrentlyawaitingahandtransplant.

Neil isabusinessmanwhounderwentaforequarteramputationin2014. Hesufferswithphantomlimbpainandhasexploredthenumeroustreatmentoptionsavailablehopingtofindsomerelief.

SarahDayisaProsthetistOrthotistandaneducator,currentlyworkingattheUniversityofStrathclyde,Glasgow.Shehasheldclinical,academicandmanagerialpostsinavarietyofinternationalsettingsincludingtheUK,Ireland,Australia,South-EastAsiaandtheMiddleEast.Sarah’steachingandresearchinterestsarefocusedaroundupperlimbprosthetics,andshehasaparticularinterestininvestigatingtheburdenofdisability,treatmentpathwaysandappropriatetechnology.YoucancontactSarahatsarah.day@strath.ac.uk

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Title: OsseointegratedProsthesesforTranshumeralAmputees;Long-termFollow-upofpatientsusingPatient-ratedOutcomeMeasures.

Presenter: KerstinCaine-Winterberger,Occupationaltherapist

RehabilitationCentreforUpperLimbAmputation,Falkenbergsgatan3,41285Gothenburg,SahlgrenskaUniversityHospital,Sweden.Tel:+46-313438127.

E-mail: [email protected].

Otherauthors:ÖrjanBerlin,KatarzynaKulbacka-Ortiz,RickardBrånemark

Background: This is a retrospective study from1994until 2013with 18 adultswith transhumeralamputationtreatedwithosseointegrated (OI) implants inGothenburg,Sweden.Twopatientswereexcluded from the study, due to removal of the implant. The treatment involves two surgicalprocedures, where a titanium fixture is operated into the skeleton and after six months a skinpenetrating abutment is connected to the fixture, to enable a prosthetic attachment. Training,prostheticapplicationandrehabilitationstartsshortlyaftersurgeryfollowingastrictprotocol(Jönssonetal,2011).

Aimsofstudy:Theaimofthisstudyisto investigatetheoutcomeintermsofprostheticuse,bodyfunction, daily activities andhealth betweenpersonsusingosseointegratedprostheses and socketprostheses. Are there any differences concerning: Prosthetic use, perceived pain/discomfort, theabilitytoperformdailyactivitiesandhealthstatus.

Material: Sixteen prosthetic users with osseointegration have been examined regarding patientreported outcome measures (PROM) and compared with upper limb amputees supplied withtraditionalsocketprostheses(SP)(22patients).ReasonsforamputationintheOI-groupwastraumain 14 cases and tumor in 2 cases. Thirteen were men and 3 were women and the mean age atamputationwas33years.Thecauseofamputation in the socketgroupwas trauma in19cases,1tumor,1infectionand1nerveinjury.Eighteenweremenand4women,born1934-1984andmeanageatamputationwas34.7years.

Method:Allpatientsanswered3questionnaires.Ashortquestionnairewasusedforobtainingdataconcerningamputation,prosthetichistoryandprostheticuse.Twooutcomemeasureswereused:theDisabilityofArmShoulderHand(DASH)andEuroQolEQ5D.DASHisawell-knowninstrumentforupperlimbswithactivitiesofdaily livinganddisabilitiesperceivedafter injury, consistingof30questions(Hudak et al 1996). EQ5D and EQ VAS health score was used as a standardized health measureconsistingof5itemsplusthehealthscore(EuroQolGroup,1990).

Results:All16intheOIgroupwereprostheticusers.Elevenusedmyoelectricprosthesis,3cosmetic-,3work-and1hook/cosmeticprostheses. Inthesocketgroup16wereprostheticusersand6werenon-users.Sixusedmyoelectricprosthesis,6cosmetic,3work-and1body-poweredprosthesis.Therewasastatisticalsignificantdifferenceinprostheticuse(p=0,023)fortheOIgroup.

TheOI-groupvstheSPshowedbetterPROMs.Therewasastatisticalsignificanceforthefollowingitems:“washyourback”,“carry”,“useknifetocutfood”,“tingling”,“sleepingproblems”andthetotalDASHscore(p=0.04).UsingEQ5D,therewasastatisticalsignificancein“anxiety/depression”(p=0.03)and“totalhealthstate”fortheOIgroup(p=0.04).

Conclusion:TheOItreatmentforTranshumeralamputeescanleadtobetterfunctionalityoftheupperlimb,higherprostheticuse,betterhealthstateandlessproblemswithanxiety/depression.

References:

JönssonS,Caine-WinterbergerK,BrånemarkR:Osseointegrationamputationprosthesesontheupperlimbs:methods,prostheticsandrehabilitation.ProsthetOrthotInt2011,32(2),190-200.

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Title: Decreasingphantomlimbpainbyvirtualreality–casepresentation

Presenter: ZPihlar,OT,Mrs

Contactaddress: UniversityRehabilitationInstitute Tel:+386(0)14758100

Linhartova51 Fax:+386(0)14376589

Ljubljana E-mail:[email protected]

1000

Slovenia

OtherAuthors:HBurger1,MOrtiz-Catalan2,3,4,1–UniversityRehabilitationInstitute,Ljubljana,Slovenia;2–DepartmentofSignalsandSystems,ChalmersUniversityofTechnology,Gothenburg,Sweden;3–CentreforAdvanceReconstructionofExtremities,SahlgrenskaUniversityHospital,Sweden;4–IntegrumAB,Mölndal,Sweden

Aimsandobjective

Between50–80%ofpatientsafteramputationhadphantomlimbpain(PLP)(1),andmanyofthemreportedthatitinterfereswiththeiractivitiesandparticipation.Inspiteofseveraltreatmentoptions,treatmentofPLPisstillproblematic(1).TheaimofourstudyistopresentacaseinwhichNeuromotus(2)was successfully used. This system is basedon theopen sourceplatformBioPatRec (3),wherealgorithmsforthepredictionofindividualandsimultaneousmovementsareimplementedtogetherwithvirtualandaugmentedreality,aswellasgamingcontrol(4).

Patientandmethods

In2011thepatientfellfromanelevator20mdeep.Hisrightupperlimbwastornaway,hewasalsoonehourunconscious,GlasgowComaScalescore isnotknown. Hewasfittedwithbody-poweredprosthesisthathewears4–5hoursperday.SincethebeginninghehadseverePLP(6orstrongeronnumericratingscale)whichinterfereswithhisactivitiesandparticipation.Hewasquitedepressedandhadnowilltoreturntoanywork.Mostofhistimehespentathome.HewastreatedwithPregabalin150mg in themorningand300mg in theevening.Heagreed toparticipate in thestudy thatwasapprovedbyEthiccommitteeofourInstitute.

Treatmentconsistedof12up to twohours longsessionsbyNeuromotus.Afterassessingpainandplacementofelectrodes,patientpracticemotorexecutioninvirtualreality(VR),playgamebyracinga car using phantommovements, andmatch random target postures of a virtual arm in VR. Thedifficultywasincreasedwhenpreviouslevelwassuccessfullycompleted.Wedidfollowupone,threeandsixmonthsafterthelastsession.Allsessionswereledbythesamespeciallytrainedoccupationaltherapist.

Results

PLPintensitydecreased(figure1).AttheendofthetreatmentwedecreasedPregabalinto75mgtwiceperdayandonemonthaftertreatmentto75mgonceperday.Hewaslessdepressedandwantedtoreturntowork,sohestartedwithvocationalrehabilitationprogram.

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Figure1:Paindistributionduringtrainingdays(12sessions)andatfollow-ups(lastthreebars)

Conclusion

ThisnovelmethodexploitingbrainplasticitywassuccessfulinreducingpersistentPLP.Studyonagreaternumberofsubjectsisneededfordefiniteconclusions.

References:

1. RichardsonC.PhantomLimbPain;prevalence,mechanismsandassociatedfactors.In:MurrayC.Amputation,prosthesisuse,andphantomlimbpain.Aninterdisciplinaryperspective.Springer2010:137–56.

2. Ortiz-CatalanM,SanderN,KristoffersenM,HåkanssonB,BrånemarkR.Treatmentofphantomlimbpain(PLP)basedonaugmentedrealityandgamingcontrolledbymyoelectricpatternrecognition:acasestudyofachronicPLPpatient.,FrontiersinNeuroscience,2014,8:24.

3. Ortiz-CatalanM,BrånemarkR,HåkanssonB.BioPatRec:Amodularresearchplatformforthecontrolofartificiallimbsbasedonpatternrecognitionalgorithms.SourceCodeBiolMed2013;8.doi:10.1186/1751-0473-8-11.

4. Ortiz-CatalanM,HåkanssonB,BrånemarkR.Real-TimeandSimultaneousControlofArtificialLimbsBasedonPatternRecognitionAlgorithms.IEEETransNeuralSystRehabilEng2014;22:756–764.

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Title: CutaneousAnchorTechnologyandCreativeSolutionstoComplexProblemsPresenter: DebraLatour,M.Ed.,OTR/LAddress: Single-HandedSolutions,LLC

105NassauDrive 413.519.0636

Springfield,MA01129 E-mail: LatourAnchor@gmail.comIndividualswithupperlimbdeficiencychoosetowearanduseprosthesistechnologyformanyreasons.Evidencesuggeststhatthesereasonsincludepersonal,socialandfunctionalpreferences.Withage,these individuals often experience difficulties with prosthetic fitting and use due to anatomicalpresentationsthatmayaffectbothoftheirupperlimbs.Thisproblemismagnifiedinthepersonwhohas acquired limb loss due to trauma. The non-amputated side may be affected by differentdebilitatingissueswhichmayimpacttheuser’sabilitytoaccesspowerfromavailablebodymovementsortoaccessmyo-signals.Theend-resultisthattheprosthesis-userexperienceschallengestousethenon-amputated ‘involved’ upper extremity and the prosthetic extremity to complete bilateralactivitiesnecessaryforindependentfunction.

TheCutaneousAnchortechnology(CAT)derivesitsprimarysourceofcontrolfromthescapulaonthesamesideofthelimbdeficiency.Becausetheharnessiseliminated,thebenefitshavethetechnologyhavebeenreportedto includemoresymmetricalbilateralupperextremitydevelopment, increasedfunction, greater comfortand improvedcosmesis.Although itwasoriginallydeveloped foruse forindividualswithinvolvementatthetrans-radiallevel,derivativesofthetechnologyhavebeenusedtosuspendandcontrolprosthetictechnologyatalllevelsincludingtrans-humeralandpartialhand.

Thispaperaddressescasesolutionsforproblemsassociatedwithaccessingpowerand/orcontroloftheprosthesisusingsimpletechnologyadvancestocomplementthemorecomplextechnologyusedinthedesignoftheprosthesis.Reflectivecasestudiesarediscussedwhichincludeinitialpresentationwith consumer-statedproblemsandconcerns, solutionsofferedand trainingprovided to theuser.Occupationaltherapistsareconcernedwiththeabilitiesofclientstoattaintheskillsvitalformaximalfunctional independence.Proficiencyintheseareasfostersanenjoyableandpositiveperceptionofqualityoflife.

Foursubjectsareidentifiedforthepurposeofthisreflection:A:70year-oldmalewithacquiredtrans-humerallossh/ofractureofresidualhumerusandinsertionofapacemakerinhischestwall(Figure1);B:31year-oldmale with recentacquired lossof dominant index fingeratPIP jointdue toanindustrialaccident(Figure2);C:45yearoldmalewithLcongenitaltrans-radialdeficiencyandsevereRepicondylitiswithshoulderandwristpain;D:61yearoldmalewithacquiredLtrans-radialdeficiencyandRrotatorcuffinjury.EachclientutilizedadiverseformofCATtomeetindividualneeds,giventhevaryinganatomicalpresentationsanddemandsoftheirprosthetictechnologywithinstructiontouseinguidedtrialsandhomeprograms.

OutcomemeasuresincludedDASHvideo-graphedUNBandprostheticsatisfactionsurvey.Preliminarydatareflectsoverallsatisfactionwiththecutaneousanchortechnologyasanalternativetotraditionalharnessing.TheCAT issimplistic indesign, isdurable,affordableandeasilyavailable.Thepotentialbenefitsof thisdeviceappear to include increased satisfaction, increasedprosthesiswear anduse(relatedtotolerance,frequencyandspontaneity)asitallowsimprovedcomfort,cosmesisandintuitiveaccesstomovementduringfunctionalactivity.

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Figure1 Figure2

REFERENCES

Atkins,DJ.ComprehensiveManagementoftheUpper-LimbAmputee(2012)SpringerLondon,Ltd.2011.

HichertM,PlettenburgD,SmitG.ForcePerceptioninIpsilateralScapularCutaneousAnchorSystemversusFigureof9ShoulderHarnessOperation,(2013)ISPOIndiaWorldCongressproceedings.

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Title: Factorsinfluencinguseandsatisfactionwithupperlimbprosthesis

Presenter: HBurger,MD,PRMspecialist,PhD,Mrs

Contactaddress: UniversityRehabilitationInstitute Tel:+386(0)14758100

Linhartova51 Fax:+386(0)14376589

Ljubljana E-mail:[email protected]

1000

Slovenia

OtherAuthors:MMlakar,CPO,MBurgar,CPO,UniversityRehabilitationInstitute,Ljubljana,Slovenia

Objectivesandaim-Touseaprosthesis,thepersonhastobesatisfiedwithit.Satisfactionmaycoverseveral domains. We found two instruments for measuring satisfaction with prosthesis in theliterature,theClientSatisfactionwithDevicemoduleoftheOrthoticsandProstheticsUsers’Survey(OPUS-CSD)(1)andtheQuebecUserEvaluationofSatisfactionwithAssistiveTechnology(QUEST)(2).OPUS-CSDhasbeenvalidatedontheupperlimbprosthesisusersinSweden(3);QUESThasnotbeenvalidatedonthispopulation.Theaimofourstudywastotheusers’satisfactionwiththeirupperlimbprosthesisatouroutpatientclinic.

Methodsandsubjects-All(51)unilateralupperlimbprosthesisuserswhovisitedouroutpatientclinicin 2014, were older than 17 years, use their prosthesis for at least one year and were willing toparticipatewereaskedtofillintheOPUS-CDSquestionnaire(3).Descriptivestatisticsandt-testwereusedfordataanalysis.ThestudywasapprovedbytheEthicCommitteeofourInstitute.

Results-Thirty-threemenand18women,19to82yearsold,amputatedoneto62yearsagofilledinthequestionnaire.Mostofthem(41,80%)hadtrans-radialamputation,andusepassiveprostheses(32, 63%). They used their prostheses from a few hours per week to 16 hours per day (mean9.5hrs/day,SD0.74).Ingeneral,theparticipantswhousedtheirprosthesismorehoursperdayweremoresatisfiedwithit(p=0.033)andratedhigherthatitfitswell(p=0.031),iscomfortablethroughouttheday(p=0.009),looksgood(p<0.001),andispainfreetowear(p=0.025).Theamputationlevelandthetypeofprosthesiswerenotassociatedwithhowmuchtimetheparticipantsworetheirprosthesesdaily.

Conclusion-ForupperlimbprosthesisusersinSloveniaitisimportantthattheprosthesislooksnice,fitswell,iscomfortableandpainfree.

References:

1. HeinemannAW1,BodeRK,O'ReillyC.DevelopmentandmeasurementpropertiesoftheOrthoticsandProstheticsUsers'Survey(OPUS):acomprehensivesetofclinicaloutcomeinstruments.ProsthetOrthotInt.2003;27(3):191-206.

2. JarlGM,HeinemannAW,NorlingHermanssonLM.ValidityevidenceforamodifiedversionoftheOrthoticsandProstheticsUsers'Survey.DisabilRehabilAssistTechnol.2012;7(6):469-78.

3. DemersL,Weiss-LambrouR,etal.DevelopmentoftheQuebecUserEvaluationofSatisfactionwithassistiveTechnology(QUEST).AssistTechnol1996;8(1):3-13.

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Title: Theinfluenceofenvironment-experiencesofusersofmyoelectricarmprosthesis,aqualitativestudy

Presenter: CathrineWidehammar,MSc,OccupationalTherapist

Address: DepartmentofPediatrics,ÖrebroUniversityHospital,SE70185Örebro,Sweden.E-mail: [email protected]: IngvorPettersson,PhD1,GunnelJaneslätt,PhD4,5,LiselotteHermansson,PhD1,2

1FacultyofMedicineandHealth,SchoolofHealthandMedicalSciences,ÖrebroUniversity,Sweden;2DepartmentofProstheticsandOrthotics,FacultyofMedicineandHealth,Örebro,Sweden;3DepartmentofPediatrics,FacultyofMedicineandHealth,Örebro,Sweden;4CentreforClinicalResearchDalarna,Sweden5DepartmentofPublicHealthandCaringSciences,DisabilityandHabilitation,UppsalaUniversity,,Sweden

Aims and objectives: Myoelectric prostheses can be prescribed to people born with upper limbreductiondeficiencyorwithacquiredamputationinordertoimprovetheirfunctionandqualityoflife.Despite this, prostheses are used in varying degrees. An environment with barriers, or withoutfacilitators,willrestricttheindividual’soccupationalperformanceandcanalsoresultinlimitationsofQualityofLife.AccordingtotheInternationalClassificationofFunctioning,disabilityandhealth(ICF)theenvironment includes thephysical, socialandattitudinalenvironment inwhichpeople liveandconduct their lives. Few studies have been made to see the impact of environmental factors onprosthesis use. In this study the ICF- model is the framework to understand the complexity ofenvironmental factors influence on prostheses use. The aim of this study was to describe users’experience of how environmental factors influence their use of a myoelectric prosthesis in bothcongenitalandacquiredabsenceofahand.

Method:Qualitativedescriptiveapproach.Semi-structuredinterviewswereaudiotaped,transcribedby the first author and analyzed through inductive content analysis according to Graneheim &Lundman.Investigatortriangulationwasusedtoensurethecredibility.

Subjects:Strategicselectionwasusedtogetavariedsample in termsofsex,age,deficiency level,etiology,currentprosthesisuse,andlengthofexperience.Interviewswereconductedwith13adultpatients, previously provided with a myoelectric prosthetic hand at the Prosthetics and OrthoticsOutpatientClinicinÖrebro,Sweden.Theparticipantswere9malesand4femaleswithagerangingfrom20-74years;theyhadacquired(n=5)orcongenital(n=8)causeofabsenceattrans-humeral(n=3)ortrans-radial(n=10)level.Theirexperiencefromprosthesisusewasrangingfrom2-30years.Atthetimeofdatacollectiontheparticipantsreporteddifferentpatternsofprosthesisuse:daily(n=6)ornon-daily(n=7),rangingfromuseonlyatworktonever.

Results: The overarching theme “Different degree of embodiment provides various experiences ofinfluence from environment” illustrates the participants’ adaptation to prosthesis, which in turninfluencestheabilitytomanageenvironmentalbarriers.Fourcategoriesemergedfromthedata,“Theprosthesisfunction”,“Otherpeoples’attitudes”,“Supportfromfamilyandhealthcare”and“Personalapproachtotheenvironment”.Environmentalfacilitatorssuchas,supportfromfamilyandhealthcare,and,goodfunctionandfitoftheprosthesis,helpedtomaketheprosthesisanembodiedexperience,leadingtodailyuse.Thisembodimentreducestheinfluenceofenvironmentalbarriers,e.g.climate,attitudes,andtechnicalshortcomings.Myoelectricprosthesisusefacilitatesactivityandparticipationamongdailyusers.Conclusions:Theembodimentoftheprosthesismayreduceinfluenceofenvironmentalbarriersandpromotemyoelectricprosthesisuseinbothcongenitalandacquiredupperlimbdeficiency.Theusers’experience in this study indicates that support and training can facilitate the embodiment ofmyoelectricprosthesis.Thus,asprescribersofprosthesesitisourresponsibilitytogivesupportandinformationtothepatientandalsotofamily,pre-schoolandschoolteachers,andlocalhealthcare,inordertomotivateandencourageprosthesisuseineverydaylife.

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Title Therelationshipbetweenprostheticcontrol,wearingpatternanddaily prosthesisuse

Presenter LiselotteNorlingHermansson1,2,3,AssociateProfessorContact DeptofProstheticsand Tel +46196025576address Orthotics V-building Fax +46196021000 ÖrebroUniversity Email [email protected] Hospital SE70185Örebro, Sweden Other HelenLindner1,PhD,SchoolofHealthSciences,ÖrebroUniversity,author Örebro,Sweden Affiliations 1

FacultyofMedicineandHealth,ÖrebroUniversity,Örebro,Sweden 2DepartmentofProstheticsandOrthotics,RegionÖrebroCounty;and 3UniversityHealthCareResearchCentre,RegionÖrebroCounty;Örebro,

SwedenAimandobjectivesMyoelectric prostheses are often prescribed to children with arm deficiency and prosthetictraining isgivenregularlybytheprostheticclinics.Onegoalofprosthesis fitting is togivethechild an assistive tool to perform their daily activities. Our clinical experience told us thatprostheticfittingshouldbe initiatedatayoungagebut less isknownwhethertheprosthesescaneasetheperformanceofthechildren’sdailyactivities.Thus,thestudyaimwastoevaluatetherelationshipbetweenprostheticcontrolandtheeaseofperformanceinusingtheprosthesistoperformdailyactivities.MethodDuring their clinic visits, pediatric prosthesis users (n=60, age 3 to 17) were asked to fill in aquestionnaire, ‘ProstheticUpperExtremityFunctional Index’,where thechild (or theparent ifthe child is under 6) rated the ease of performance in using the prosthesis to perform 26-38dailyactivities.Thenthechildperformedabimanualactivityandanoccupationaltherapistfromtheclinic (n=6)assessedthechild’sprostheticcontrolwithanassessmenttool ‘AssessmentofCapacity for Myoelectric Control’. Pearson r was used to calculate the correlation betweenprostheticcontrolandeaseofperformance.Multiple regression analysis was used to assess the capacity for control, wearing pattern andagetopredicttheeaseofperformanceinPUFIactivities.ResultsA strongcorrelation (Pearson0.68)was foundbetweenthe levelofprostheticcontrol (ACMCscore) and the ease of performance in using the prosthesis to perform daily activities (PUFIscore). The multiple regression model showed that the percentage of variance increased by26.7%whenACMCscoresandwearingpatternwereadded into themodel.Whencomparing

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ACMC scores and wearing pattern, the ACMC scores have a higher beta value (0.48) thanwearingpattern.ConclusionThe correlation between ease of performance and prosthetic control suggests that amyoelectricprosthesiscaneasetheperformanceoftheirdailyactivitiesifthechildhasagoodprostheticcontrol.References

1. WrightFV,HubbardS,NaumannS,JutaiJ.Evaluationofthevalidityoftheprostheticupperextremityfunctionalindexforchildren.ArchPhysMedRehabil.2003Apr;84(4):518-27.

2. HermanssonLM,FisherAG,BernspangB,EliassonAC.Assessmentofcapacityformyoelectriccontrol:anewRasch-builtmeasureofprosthetichandcontrol.JRehabilMed2005;37(3):166-71.

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Title: Symptom severity and prosthesis use; exploring the pain experience using theDisabilitiesoftheArmShoulderandHand(DASH)

Presenter: LewisMackay,OccupationalTherapist(Touchbionics),MrAddress: TouchBionics,Unit3AshwoodCourt,Livingston,EH530THE-mail: [email protected] OtherAuthors: BertrandFrossard,MarketDevelopmentManager,TouchBionics–Livingston.Aimsandobjectives:Thepainexperienceofamputeeshasbeenidentifiedasanimportantfactorinrelationtoprosthesisuse(1),andasanoutcomethatcanchangeasaresultofprosthesisuse.TheauthorshavepreviouslyreportedonfunctionaloutcomesrecordedusingtheDisabilitiesoftheArmShoulderandHand(DASH)outcomemeasure(2),howevertheaimofthestudywastoexploretheeffectonspecificallytheselfreported symptomseverity scoreof theDASHasa resultofprosthesisuse.Theauthorsaimed toestablishiftheuseofaprosthesishadanimpactonthelevelsofpainreportedandifthisvariedacrosslevelsofabsenceororiginoflimbabsence.Method:Thecohortconsistedof25IndividualsreportingonoutcomesviaanonlineplatformcomprisedoftheDASHquestionnaireinadditiontoquestionsrequestinglevelofabsence,causeoflimbabsence,andvarious other questions to establish if the populationwas representative. The entire cohortwerecurrentprosthesisusers.Thedemographic informationallowedtheeffectofprosthesisuseonthesymptomseverityscoretobeanalysedacrosssubgroups.AWilcoxonsignedranktestwasusedinadditiontothedescriptivedatatoensurethatchangeintheresponseswasnotdispersed,andtoprovidemoredetailaboutthenatureofchangeacrossthegroup.Presentedbelowaretheresultsforthepartialhandsubgroup.Thesedatawillbecomparedfortheoverallpainratingacrosssubgroupsincludingpartialhand,trans-radial,aboveelbow,andcongenital.Thecongenitalsubgroupwillactasacontrol.Results:

Painrating

Prefitting 3months

Patients % Patients %

None 9 36.0% 13 52.0%

Mild 8 32.0% 8 32.0%

Moderate 6 24.0% 3 12.0%

Severe 2 8.0% 1 4.00%

Total 25 100% 25 100%

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Prefittingand3monthsWilcoxonsignedRankstest–Overallpainrating

WilcoxonsignedRanksTest

Fullcohort(n=25patients)

3months

–

Prefitting

N MeanRank SumofRanks

NegativeRanks 8a 5.13 41.00

PositiveRanks 1b 4.00 4.00

Ties 16c

Total 25

a.3monthsrating<Prefittingratingb.3monthsrating>Prefittingratingc.3monthsrating=Prefittingrating

Test(statisticZ):

Z

Asymp.Sig.(2-tailed)

-2.31

.021

Conclusions:The self reported measure of pain recorded by question 24 of the DASH showed a statisticallysignificantreductioninpainsymptomsfrompretopostprosthesisuseoverthecohort.Thispositiveeffect was also observed for questions relating to pain when performing a specific activity andstiffness.Theseresultsindicatethatpoweredpartialhandprosthesescanprovidebenefitstothepainexperienceofpartialhandamputees.References:

1. ResnikL,MeucciMR,Lieberman-KlingerS,etal.AdvancedUpperLimbProstheticDevices:ImplicationsforUpperLimbProstheticRehabilitation.ArchPhysMedRehab2012;93(4):710-717.

2. HudakPL.AmadioPCandBombardierC.Developmentofanupperlimbextremityoutcomemeasure:theDASH(disabilitiesofthearmshoulderandhand).AmJMed1994;29(6):602-608.

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Title: Useofmyoelectricprosthesesandparticipationineverydayactivities–environmentalfactorsimpactonassistivetechnologyuse

Presenter: CathrineWidehammar,MSc1,2,3,OccupationalTherapistAddress: DepartmentofPediatrics,ÖrebroUniversityHospital,SE70185Örebro,Sweden.E-mail: [email protected]: LiselotteHermansson,PhD1,2,HeleneLidströmPhD4;

1FacultyofMedicineandHealth,SchoolofHealthandMedicalSciences,ÖrebroUniversity,Sweden;2DepartmentofProstheticsandOrthotics,FacultyofMedicineandHealth,Örebro,Sweden;3DepartmentofPediatrics,FacultyofMedicineandHealth,Örebro,Sweden;4DepartmentofSocialandWelfareStudies,FacultyofMedicine,Linköpingniversity,Sweden

Introduction:Inrehabilitation,assistivetechnology(AT)suchasmyoelectricprostheses(MEP)canbeprescribedinordertoimprovethefunctionalcapabilityofindividualswithdisability.Well-functioningATcanbecrucialforactivityandparticipationinsociety.Sadly,thedevicesprescribedarenotalwaysused.InarecentqualitativestudywithpersonswhouseMEPwefoundthatdifferentaspectsoftheenvironmenthaveabig impactonuseof theprosthesisbut further studiesbasedonquantitativemethodologywereneeded.Hence,theaimofthisstudywastoinvestigatetheprevalence,frequencyandmagnitudeofenvironmentalbarriersandfacilitatorsthatmayhaveanimpactonMEPuseandincomparisonwith users of poweredmobility devices (PMD) and assistive technology for cognition(ATC).

Method:Across-sectionalsurveywithgroupcomparisons.ThesurveycontainedtheSwedishversionof Craig Hospital Inventory of Environmental Factors (CHIEF-S) and a study-specific questionnairefocusing on facilitating factors. In CHIEF-S respondents rate the occurrence of 25 environmentalbarriersbasedbothonfrequencyandmagnitudeofthebarrier.ThetotalCHIEF-Sscoreiscalculatedbasedonthemeanoftheproductofmagnitudeandfrequency,rangingfrom0to8.Higherscoreindicate greater experienceof environmental barriers. The study-specific questions asked about 7environmentalfactorsthatfacilitateuseofAT,thesewerescoredonafive-pointratingscalerangingfrom0=notatall,to5=verymuch.ThefrequenciesofenvironmentalfactorsarepresentedasbarriersorfacilitatorsandanalyzedbothfordifferenceswithinandbetweenthethreeATgroups.SincethescoreswerenotnormallydistributedKruskalWallistestforsignificance(p<0.05)and2-tailedMann-WhitneyU test fordifferencesbetween thegroupswereused foranalyses.156participantswererandomly identifiedandanswered the survey.Of these,51 (33%)wereMEPusers,58 (37%)PMDusers,and,47(31%)ATCusers.TheexperienceofusingATvariedbetween1-41years,mean=11.6,(MEPmean=22.9,PMDmean=7.1,and,ATCmean=3.7).Morethan2/3oftheparticipantsusedtheirATdaily(MEP=80%,PMD=64%,and,ATC=87%).

Results:TheenvironmentalfacilitatorsupportandencouragementfromrelatedpersonswasscoredhighforusersofMEPandPMD,whilesupportfromrulesandregulationswaslowestforusersofMEPandATC.EnvironmentalbarriersweresignificantlowerforMEPthanfortheentiregroupofAT(exceptsub-score work/school). Median CHIEF-S total score were MEP=0.120, PMD=0.619, ATC=1.560.PersonswithMEPwhousedtheirATdailyscoredtheleastbarriers(median=0.080)whereaspersonswithATCscoredthemostbarriers(median=1.560).

Conclusions:ProsthesisusersexperiencelessbarriersfromtheenvironmentandhaveahigherlevelofparticipationinsocietycomparedtopeopleusingPMDorATC.ThefacilitatingfactorSupportfromrulesandregulationswasratedlowestforMEP,whichmayreflectthesystemforprescribingadvancedtechnologyinSweden.

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Title: WebbasedinnovativecareusingGemstrackerAADA,introducingremotefollowup(monitoring)offunctioning.

Presenter: LisetteM.Melis-Schrijver,OccupationalTherapist.Address: CongenitalArmDeficiencyorAmputation(AADA)Team

RijndamRehabilitationInstitute,AtErasmusMedicalCenter,Wytemaweg803015CNRotterdamTheNetherlands.

Co-authors: M.S.denHollander–Ardon,PhD,PT,CHT-NL

V.G.vanHeijningen,OT,CHT-NLJ.Worst,SocialWorkerR.vanderVeen,MSc,PTW.G.M.Janssen,PhD,MD.H.J.Stam,PhD,MD

Aimsandobjectives:TheintroductionofPatientRelatedOutcomeMeasures(PROM's)resultsfrom"empowerment” of patients, it is increasingly used to evaluate the effectiveness of treatment.Moreover,itenablesshareddecisionmakingandthereforehighercompliancetotreatment.However,paper and pencil registration is time-consuming for both patients and health care specialists.Therefore, the aimof this studywas todevelop a custom-builtwebbased registration,which alsoallowscomparisonbetweenpatientsandtreatments.Methods:WebuiltaregistrationsystemusingLimeSurveysoftware,anopensourcesystem.ReliableandvalidquestionnairesthatarewidelyusedinRehabilitationMedicinewereincorporated.Theygiveinformationon functioningonalldomainsofhuman functioningasdescribed in theWorldHealthOrganization’s Classification of functioning (ICF and ICF-CY). The Gemstracker registration systemenables patients, physicians and / or therapists to enter information in a secureweb application,namedGemstrackerAADA.Weuseamonitoringprotocolforbothchildrenandadults,specifiedinagegroupswithemphasisonHealthRelatedQualityoflife.Results:GemstrackerAADAmakesthisinformationavailablebothincareregistrationprotocols,inindividualquestionnairesandmeasurement forms.Eachquestionnaire isassociatedwithauniquetoken which makes PROM’s and therapist-reported outcome measures digitally traceable.Wealreadyenrolled122patientsintheGemstrackerAADAregistration.Theonlinecareregistrationprocedureisdescribedasaprotocol,startingwiththefirstpatientcontact.WeuseGemstrackerAADAasastructuredonlinelong-termfollow-upcareregistrationwithintherehabilitationprocess,therebymaking outcome measures transparent for clients and professionals within the AADA group.GemstrackerisabletoshowPROM’sbothinICFandICF-CYdomains,inagegroups,andinaverageassignedGemstrackerregistrationprotocols.Discussion:GemstrackerAADAisasecurewebbasedapplication,whichistotheadvantageoftimemanagement.Byautomaticallysendingplannedquestionnairesandbeinglesstimeconsumingthanpaper and pencil registration it will lead to higher compliance and an increase of client centeredpractice. GemstrackerAADAusesopensourcesoftwareso therefore, futureprojectscanbenefitfromadditionalfunctionssuchasdevelopedforthisproject,forinstancelinkingtoelectronichealthrecordsandconstructingdatabasesforresearchdataetc.Moreover,itenablesmultiplecaregiverstoviewthedata.Theapplicationcanbeusedasatrackingsystemanditcanalsoeasilybeusedforlongtermfollowup.

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Title: Comparisonofprostheticterminaldevicegripforceadjustabilitybetweenmyoelectriccontrol&Bowdencablecontrol

Presenter: KengoOhnishi,Engineer,Dr,TokyoDenkiUniversity

Address: Ishizaka,Hatoyama,Hiki,Saitama,Japan,350-0394

Tel: +81-49-296-1691

Email: [email protected]

OtherAuthors: YuukiWatanabe,Engineer,TokyoDenkiUniversity

Number of upper limb prosthetic hands have been developed and evaluated with engineeringinstrumentsandoccupationaltherapyprotocols.Theassessmentmethodsofmovingcertainobjectandmeasuringtheoperationtime,asinSHAPtest,aresimpleandeffectiveforcomparingtheterminaldevicesandusers’ability.However,theresultsofthesetestareeffectedbythemechanicalpropertyofthedeviceandobject,andtherefore,theresultdoesnotsimplypresentthedifferencebetweenthecontrolmethod.Inthisreport,wetargettocomparetheoperabilityofthetwo-sitetwo-functionproportionalmyoelectric control systemand theelbowoperatedBowdencablecontrol systembymeasuringthesettlingtimetoadjusttothetargetpinchforce.

Ten non-amputated subjects in their 20’s year-of-age were tested. The subjects with no initialexperienceofcontrollingaprostheticdeviceandmyoelectricsignalcontrolwererecruited.Thetargetgripforceofthedeviceweresetfrom5to25Nat5Nintervalandthetargetforceweresetrandomly.Theterminaldevicewerefixedtoaframeandthearmwiththesensororcontrolcablewereplaceonthetable.Thedigitswereadjustedtohaveminimalexcursionbetweenthedigitandforcesensor.TheBowden cablewere assembledwith 2 setups: firstwaswith standard cable and housing and thesecondwaswithlowfrictionlinerinstalledinthehousing.Thetrialsweremeasuredandrecorded,andtheperformancesofthesoundhandgripwerealsomeasuredasreference.

ResultsshowthatthesettlingtimeforoperatingtheBowdencablecontrolledterminaldevicewasequivalenttothatofsoundhand,andbetterwhenthetargetforcewasover20N.Furthermore,thedispersionamongtheindividualweresmallerfortheBowdencablecontrolledwhencomparingtheresult of the myoelectric controlled. The settling time of the myoelectric control had the worstperformanceat5Nand the standarddeviationswerealso larger for all target force.However theperformanceofthemyoelectriccontrolledimprovedasthetargetforcebecamelarger.

Theresultofthisexperimentshouldbereadwithknowledgethattheallsubjectwereattheentrylevelofcontrollingtheterminaldevice.Theywereprovidedwithtimetoadjusttoopeningandclosingthehandbutnotfullytocontrolthepinchforcebeforestartingtheexperiment.

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Title: ScottishSpecialistProstheticsService:Advancesinourunderstandingwithfitting,training,providingandmaintainingmulti-articulatingupperlimbprostheticsforourpatients

Presenter: BrianGarrett,AdvancedPractitionerOccupationalTherapistAddress: SMARTCentre,133GrangeLoan,Edinburgh,EH92HLTelephone: 01315379107Email: [email protected]: AnneSillitoe,SeniorProsthetistBSc(Hons)ProstheticsandOrthoticsAddress: WestMARC,QEUH,1345GovanRoad,Glasgow,G514TFTelephone: 01412012624Email: [email protected]:BrianGarrett,AdvancedPractitionerOccupationalTherapistAnneSillitoe,SeniorProsthetistBSc(Hons)ProstheticsandOrthoticsSinceitsinceptiontheScottishSpecialistProstheticsService(SSPS)hasenabledourmulti-disciplinaryteams to fit and train multiple patients with upper limb multi-articulatingprostheses.Fourteenpatientswithtrans-radialupper limbdeficiencyhaveprogressedthroughtheprogram and been fitted with bebionic or i-limb hands. They have participated in fitting,trainingandhaveutilizedtheirprosthesesforlongerthansixmonths.Ourknowledgebaseandclinicalskills have increased fromproblem solvingdifficulties and learning from the successes incurred inprogram development and providing service for our patients. The program has given us anopportunity to go through the process with multiple patients and more fully understandthe similarities and differences in provision ofmulti-articulating prostheses withmore traditionalprostheses. We will review our experiences with staff training, patient education, outcomemeasurescompleted,fitting,productselection,repairsandourongoingstruggles.Key recommendations and conclusions: The provision of multi-articulating prostheses has beeneffectivewithpatientswhoareappropriatelyeducatedandselected.Withthetransitionfrommoretraditionalprosthesestoamulti-articulatingprosthesis,ithastobeexpectedthatincreasedpatienteducation, contact, training and maintenance will be required. The provision of this type ofequipmenthasofferedincreasedselectionandopportunitiesforourpatients.WehopetocontinuetohaveaccesstotheScottishSpecialistProstheticsServiceandusingtheextraskillsandknowledgewehaveacquired,successfullyprescribethecorrectprescriptiontofuturepatients.

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Title: ReportofsurveyonsituationandtheuseofunilateralTRmyoelectrichandin

Japan:Comparisonbetweencontinuoususerandsuspendedtousegroups

Presenter: JumpeiOba,OT,Mr

Address: KobeGakuinUniversity,DepartmentofOccupationalTherapy FacultyofRehabilitation 518Arise,Ikawadani-cho,Nishi-ku Kobe,Japan,651-2180

Tel＆Fax: +81-78-974-1962


OtherAuthors:A.Nakagawa1),Y.Shibata2),F.Mizobe2),T.Chin2）

1）KobeGakuinUniversity 2）HyogoRehabilitationCenter

Introduction

WehadasurveyofunilateralupperextremityamputeeswhohadprescribedthearmprosthesesinJapan.ThepurposeofthesurveywastoknowthesituationofthemyoelectrichandandhowtheyusethehandintheirADLs.Theaimofthisreportistomakeclearthecurrentsituationandtheproblemsrelatedtothemyoelectrichanduseandthenreconsidertherehabilitation.

Method

Aquestionnairewassenttothemthroughmail.Thecontentsofthequestionnaireincludedsex,age,ageatinjury,sideandlevelofamputation,typeofprosthesis,howmanyhourstousethehandinaday,hadreceivedtheoccupationaltherapyornot,andthescaleofsatisfactioninVAS.

Result

49caseshadanexperiencetousethemyoelectrichand.Theywere35malesand14females,31rightand18leftamputees,36werecontinuoususersand13suspendedtouse.Thecontinuousgroupusedthehandfor10.3±1.96hoursadaybutthesuspendedgroupusedfor14.08±2.27hours.91.6%ofthecontinuousgroupreceivedtherehabilitationtrainingbytheoccupationaltherapistsbut53.8%ofthesuspendedgroupreceivedit.

Discussion

Thecontinuousgroupisconsideredtousethemyoelectrichandeffectivelyintheiractivitiesofdailyliving.TheresultalsoshowsthattherehabilitationtrainingbyOTisessentialfortheamputeestousetheirmyoelectrichandscontinuously.WewillreporttheusabilityandproblemsintothedetailatTIPS2016.

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Title:TextileElectrodesforAcquisitionofMyoelectricSignalsPresenter:ShannonBrownContactAddress:ChalmersUniversityofTechnology Tel:+14806284888DepartmentofSignalsandSystems Email:[email protected]örsalsvägen11,SE-41296GöteborgOtherAuthors:MaxOrtiz-Catalan;ChalmersUniveristyofTechnology,SahlgrenskaUniversityHospital,andIntegrumAB,Gothenburg,Sweden,JoelPetersson,KristianRödby;FacultyatUniversityofBorås,Borås,SwedenandFernandoSeoane;FacultyatUniversityofBorås,Borås,SwedenandKTH-RoyalInstituteofTechnologyHuddinge,Sweden.ObjectiveTraditionally Ag-AgCl electrodes are used to acquire surface Electromyography (sEMG)signalsbecausetheconductiveadhesiveintheelectrodeslimitmotionartifactsanditsgelconductive layerensuresagoodenoughskin-electrodeinterfaceforvoltagesensing,mostoften, guaranteeing high quality signal acquisition. However, these electrodeswhen usedforextendedperiodsof timecauseskin irritation1.Thisstudyattempts toevaluatea fullyintegrated smart textile band for sEMG acquisition for pattern recognition of upper armmovements. The textile band contains electrical connecting tracks knitted with intarsiatechniquesandknittedtextileelectrodes(textrodes).Thisdevelopmentaimstosimplifytheuser interface for everyday muscle training and decrease overall skin irritation whencompared to traditional gel electrodes for applications such as phantom limb paintreatment.MethodsMyoelectricpatternrecognitionformotorvolitionandsignal-to-noiseratio(SNR)wereusedtocomparethetextrode’ssensingperformanceversustheconventionalAg-AgClelectrodesin offline and real-time evaluations. In the recording session three repetitions of eachmovement were performed and the EMG superficial biopotential was acquired with asamplingfrequencyof2000Hzforameasurementtimeof10secondsandadutycycleof50%.i.e.5secondmovementtimewitha5secondrestbetweenmovements.Thetextrodeswerewetwith2mlofundistilledwater to improveskinelectrode interface2.Fivehealthysubjectsbetween theagesof 22-30aswell as a transradial amputeewere testedusingamotion test of six upper arm movements to compare the performance of the twoelectrodes.

ABSTRACTS-Friday30September(inorderofpresentation)

Addthistothetopofthenextpage–ShannonBrownabstract

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ResultsandDiscussionNosignificantdifferenceswerefoundbetweenthetextrodesandtheAg-AgClelectrodesinSNRandpredictionaccuracyobtainedfrompatternrecognitionclassifiers.Figure1belowshowstherange of classification accuracy for the 5 subjects and transradial subject in real-time. In allmovementsthetextrodeperformedinthesamerangeofaccuracyastheAg-AgClelectrode.Themedian differenceon average in accuracy of the two electrode types is approximately 1.0%.ThissuggeststhatthetextrodescouldserveasareplacementfortraditionalAg-AgClelectrodesforsEMGacquisition.

Figure1.MovementSpecificPatternRecognitionAccuracyofcompletedmovementsforSixCoreMovementsacross5subjects,andtransradialsubjectrepresentedbythetriangle,inrealtime(OpenHand,CloseHand,FlexHand,ExtendHand,Pronate,SupinateandAverage).Targetsrepresentmedian

whilethe+representsoutliersinthedatasetConclusionFurther research isongoing regardingmovementclassificationofagreaternumberoftransradial amputees and the influence of washing and wearing on the sensorizedband’s performance. If the results continue to support this fully textile sensorizedgarment as suitable sensing interface for acquisition of sEMG, this might be thecornerstone enabling the use of conductive smart textiles for novel applications inmusculartherapiesforamputees.References:1 Meziane, N., Webster, J.G., Attari, M., and Nimunkar, A.J. Dry electrodes forelectrocardiography.PhysiologicalMeasurement2013;34:R47.2 Löfhede,J.,Seoane,F.,andThordstein,M.TextileElectrodesforEEGRecording—APilotStudy,Sensors2012;12:12.

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DIGITALCONTROLLERFORARTIFICIALLIMBSFEDBY NEUROMUSCOLARINTERFACESVIAOSSEOINTEGRATION

ENZO MASTINU, Signals and Systems dept., Chalmers University of Technology Email: [email protected] Max Ortiz-Catalan, Signals and Systems dept., Chalmers University of Technology Integrum AB, Göteborg, Sweden Email: [email protected] Bo Håkansson, Signals and Systems dept., Chalmers University of Technology Email: [email protected] Although thedevelopmentofbioelectricallycontrolledupper limbprosthesis startedin the 1970’s, themajority of amputees do not use this technology due to its poorfunctionality,reliabilityandcomfort.ThisstudyisbasedonthepreviousworkconductedbyOrtiz-Catalan,Håkansson,andBrånemark,whodevelopedapermanentbidirectionalinterfaceintothehumanbody,namelytheOsseointegratedHuman-MachineGateway(OHMG)1,2(Fig.1).

Figure1.OsseointegratedHuman-MachineGateway(OHMG). Theaimof thisstudywastodevelopanArtificialLimbController (ALC)thatdecodesmotorvolitionandprovidessensoryfeedbackusingtheOHMG(Fig.2).Thesystemiscomposedby3stackedmodules(Fig.3):

• Neurostimulator(NS)• Mixedsignalsprocessingunit(MSPU)• Prostheticcontrolunit(PCU)

TheMSPUisresponsibleformanagingallthemodules,bioelectricandartificialsignalprocessing,andmotorvolitiondecoding.IntheMSPUbioelectricsignalsaredigitalizedat 24 bitswith a variable sampling rate. Band-pass and power line notch filters areimplemented via firmware. Pattern recognition and direct control algorithms areimplementedandwereevaluatedinreal-time.ThedatafromtheforcesensorsintheartificiallimbisthenusedtomediatethestimulationpulsesthataregeneratedbytheNS toelicit theperceptionof touch. In its simplest stimulationmode,amplitudeand

69

pulse-widthareconstantwhile the frequencyvariesproportionallywith thegraspingforce.A communication dongle can be plugged into the system providing wirelesscommunicationwith a PC for fitting,monitoring and datamanagement. The systemincludes a SD card to continuously keep track of all relevant processes in order tobetterunderstandprostheticuseandthepotentialsourcesoferrors. Inertialsensorsarealsoincludedinthesystemnotonlytocomplementinformationonprostheticuse,butalsotopotentiallyimprovethecontrollabilityofthesystembyincorporatingsuchinformation in themotor volitiondecoding task. This systemhaspassedbench testsandiscurrentlyunderclinicalimplementation.

Figure2.Systemoverview

Figure3.PCBs.

References: [1] R.Brånemark,Ö.Berlin,K.Hagberg,P.Bergh,B.Gunterberg,andB.Rydevik,“Anovel

osseointegrated,percutaneousprostheticsystemfortreatmentofpatientswithtransfemoralamputation:Aprospectivestudyof51patients,”BoneJt.J,vol.96-B,no.1,pp.106–113,2014.

[2] M. Ortiz-Catalan, B. Hakansson, and R. Branemark, “An osseointegrated human-machine

gateway for long-termsensory feedbackandmotorcontrolofartificial limbs,”Sci.Transl.Med.,vol.6,no.257,pp.257re6–257re6,Oct.2014.

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Title: ImpactofUpperLimbVC-VOProsthesisSimulatorsinProstheticRehabilitation

Presenter: DebraLatour,M.Ed.,OTR/LContactAddress: TRSProsthetics Tel:413.519.0636

3090SterlingCircle,StudioA FAX:303.444.5372Boulder,CO80301 E-mail: [email protected]

Evidencehasbeenpublishedregardingthebeneficialimpactofprosthesis-simulators.Bittermann(1968)citesuseofsuchsimulatorswiththenon-amputee.Thisconcepthasbeenutilizedfordecadesto impartempathyandtofacilitate understanding operation of the body-powered technology. Companies such as Otto Bock and TouchBionicsusesimulatorstoassessmyo-sitesandtodevelopcontrolsskillsduringpre-prosthetictraining.Weeksetal(2003)discussestheuseofasimulatorwithuninvolvedupperlimbtosuccessfullytransferskillofprosthesisusetotheinvolvedupperlimb.Teachingindividualswithupperlimbdeficiencytobecomeadeptwiththeprosthesis,itsuseand integrationof it into acquisitionof skills related to activitiesofdaily living,work, recreationand socialinteractions can be challenging. As any practitioner of occupational therapy services knows, it is integral forbeneficial outcomes that caregivers and other family members be involved in the process. Carry-over ofrecommendationsforallaspectsofwearscheduleoftheprosthesis,skills-drillsactivitiesandadaptivestrategiesandtechniquesisessentialforthesuccessfuloutcomesoffunctionalindependenceandpositiveperceivedqualityof life. Although familymembers and other caregiversmay be present during the prescriptive and therapeuticphasesoftheprostheticprogram,theyoftenlackfirst-handexperienceofwearingandutilizinganactualprosthesis.Simulatorsoflimitedtechnology,suchasavoluntary-openingdevicemaybeavailabletoprovidethisexperienceonalimitedbasis,butnotreadilyaccessibleonanongoingbasis.Thistechnologyistypicallyusedtoprovideaforecasttotheconsumerrelativetoexpectations.Suchsimulatorshavealsobeenusedwithcliniciansandpeergroupstoadvocateempathyandrespectforindividualswithupperlimbdifferencesandtoenhanceunderstandingofwhatisinvolvedtostrategicallyutilizebody-poweredprosthetictechnology.

Itappearsthattheconceptofutilizingsimulatorsisunderutilized.Thebody-poweredprosthesissimulatordescribedaccesses both voluntary-opening and voluntary-closing terminal devices. As described in this presentation ofreflectivecasestudies,theprosthesissimulatorcanbeused inmultiplestagesofprosthetictraining.Duringtheinitial evaluation, the simulator canbeused to compare function and access of the technologies for successfulprescription and actual client trial. This evidence can be video-taped and photographed to provide compellingevidencejustifyingmedicalnecessitytothefundingstakeholder(s). Inaddition,thecaregivercanexperiencethediverse technologies in order to better understand the requirements of use and application to functional andbimanualmanipulativetasks.Duringthepreparatoryphase,theusercanadjusttothedemandsofsuspensionandpracticepre-prostheticskills-drillsandactivities.Upondeliveryof thedefinitiveprosthesis, thesimulatorcanbeutilizedtoeducatethefamilymembersandcaregiverstovariousstrategiesinordertocompletebimanualtasks.Theseopportunitieswiththesimulatorappeartoenhancecarry-overofstrategiestofacilitateskillacquisitionandappropriationofprostheticsatisfaction.Casepresentationsofdiversegroupsmentionedwillbedescribedduringthispresentation.

REFERENCES

MitchellMetal.ProstheticEducation:AreOccupationalTherapyStudents’NeedsBeingMet?OpenJournalofTherapyandRehabilitation;February2014,(2)1

WeeksDLetal(2003)TrainingwithanUpperLimbProstheticSimulator;ArchivesofPhysicalMedicineandRehabilitation84.437-443

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Title: Apreliminarystudyoncharacterisationoffingerinterfacekineticsusingapressureandshearsensorsystem

Presenter: NicholasHale,PhDStudent

Address: EngineeringandtheEnvironmentUniversityofSouthamptonHighfieldSouthamptonSO171BJ

Tel: 02380-598746


OtherAuthors

MariaValero,JinghuaTang,MichaelMcGrath,PiotrLaszczak,JianlingGao,DavidMoser,LiudiJiang–UniversityofSouthampton

Introduction:Activeprosthetichandscouldbenefitfromtactilefeedbackatthefingerswhenperformingavarietyofdailyactivities,suchasgraspingandmanipulatingobjects.Thisrequiresreal-timemonitoringofpressureandshearattheinterfacebetweenthefingersandobjects.Althoughsomepressuresensorsareavailable,littleworkhasbeenreportedonsensorsystemscapableofsimultaneousmeasurementofpressureandshear,despitethefactthatshearmonitoringiscrucialindetectingobjectslipandmovement1.Anoveltri-axialpressureandshearsensorsystem(TRIPS)hasrecentlybeenreportedtobeapplicableatthecriticalresiduum/socketinterfaceforlowerlimbprosthetics2.ThispreliminarystudyaimstoexpandthepotentialapplicationsoftheTRIPSsensorsystemtoupperlimbs,inparticular,bymonitoringdynamicloadsatfinger/objectinterfaceduringtypicalobjecthandlingtasks.

Method:BaselinecalibrationsfortheTRIPSsensorsystemwereconductedinresearchlabsettingsusingspecificallydesignedtestprotocols.Synchronousfunctionoffivesensorswasstudiedindetail.Subsequently,uptofivesensorswere attached to the finger phalanges of a healthy participant’s hand. The participant performed typical dailyinteractivetasks,suchasgrasping,holdingandmanipulatingobjects.Real-timepressureandshearvaluesatvariousphalanxlocationsandfingerdigitswereobtainedandanalysedasafunctionoftheseactivities.

Result:Peakvaluesofpressureandshearwerereportedandcomparedwithresultsinliterature.Thesepressureandshearvaluesasafunctionoftimeprovidecharacteristickineticinformationassociatedwithmanipulationofobjects.Sensoroutputsatdifferentanatomicallocations,i.e.theproximal,intermediateanddistalphalangesrespectively,alsogivesomeindicationsofnaturalhandmovementcharacteristics,includingflexionandextensionofthetendons.The initial resultssuggestthatthedevelopedTRIPSsensorsystemcouldbeusedathand/fingerinterface for dynamic load feedback. As such, the system could be potentially exploited in various areas, forexample, to assess rehabilitation outcomes for stroke patients, to assist design and provide load feedback forprosthetichands,andtoprovideinputforrealtimesimulationofupperlimbdynamicfunctions.

Conclusion:ThisstudyprovidespreliminaryevidencethattheTRIPSsensorsystemcouldbeusedattheinterfacebetweenfingerandobjecttomonitordynamicchangesinpressureandshear.Thepotentialapplicationscouldbefurther expanded to areas in studies of upper limb functions, advanced prosthetic development, and assistivetechnologiesforrehabilitation.

References1.KappassovZ,CorralesJandPerdereauV.Tactilesensingindextrousrobothands-Review.RoboticsandAutonomousSystems.2015;74:195-220.

2.LaszczakP,JiangL,BaderDL,MoserDandZahediS.Developmentandvalidationofa3D-printedinterfacialstresssensorforprostheticapplications.MedEngPhys.2015;37:132-7.

Title: ValidationofAnyBody™modelkinematicsforcharacterisingprosthesisfunctionalusage:acomparisonwithVicon®Plug-in-Gaitmodel

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Presenter: MrVikranthH.Nagaraja,D.Phil.Student,Mr

ContactAddress: InstituteofBiomedicalEngineering,UniversityofOxford,Oxford,OX37LD


OtherAuthors: DrMarkS.ThompsonandDrJeroenH.Bergmann

Therehasbeenan increased interest toobjectively and scientifically assess compensatorymovementpatterns.Compensatorymovementsadoptedduringfunctionalusageofupperlimb(UL)prosthesishavebeenlinkedtothepoor outcomes widely reported in literature [1]. Most studies characterising these movements are limited tokinematicanalysesandfewstudieshavefocusedonmusculoskeletalmodellingandunderstandingthesemovementpatternsatadynamicslevel.Thekinematicsthatdrivethemusculoskeletalmodelneedtobecorrectbeforesuchamodelcanbeappliedtoestimatemotiondynamics.

Inthispreliminarystudy,weseektovalidateoutputscalculatedbythecommerciallyavailablesoftwareAnyBodyModellingSystem™(AMS) [2].The jointanglescalculatedby thestandardAMSmodelavailable in theAnyBodyManagedModelRepository(AMMR)arecomparedwiththeoutputsfromthecommonlyusedVicon®Plug-in-Gait(PIG)model.WehaveappliedwristbracingtosimulatelackofacontrollabledistaljointduringprostheticlimbusageonULkinematics,especiallyattheproximaljoints,shoulderandelbow.

ThisstudywasapprovedbythelocalResearchEthicsCommittee.Oneright-handedable-bodiedparticipant(Age:25years,Height:1.75m,Weight:75.4kg)providedinformedconsentandparticipatedinthestudy.Prosthesisusagewassimulatedbyuseofawristbracethatmimics lackofacontrollablewrist inatypicalprostheticdevice.Theparticipant performed three trials of range of motion (RoM) tasks (wrist flexion/extension (WFE) and wristabduction/adduction (WAA) tasks) and ‘reach and grasp’ task along two directions (anteroposterior (RGF) andmediolateral(RGR)axes)inagaitlaboratorysetting.Inordertostandardisetheprotocol,thereachandgrasptaskswere performed in a seatedposition on a height-adjustable chair and using a custom-built apparatus thatwasadjustedtotheparticipant’sreachingdimensionsatelbowlevel.ThePIGandtheAMSmodelswerecustomisedtomatchparticipant’santhropometricdimensions.Rawmarker trajectories from themotioncapture systemwereusedtodrivetheAMSmodel.

TheoutputsfromthetwomodelsarecomparedbycomparingthedifferenceinmaximumRoManglesandtherootmeansquare(RMS)errors.BothAMSandPIGmodelshaveshowedanincreaseinjointRoManglesatshoulderandelbowforwristbracedcondition.InitialresultsseemtoindicatethattheoutputsfromboththePIGandAMSmodelsare comparable. Further investigationswill beundertaken that involve inversedynamics-basedmusculoskeletalanalysisofthecompensatorymovements,andassessjointandmuscleloading.

Keywords:Prostheticdevice,Compensatorymovements,Simulatedprosthesisusage,Musculoskeletalmodelling,Validation,Motionanalysis,Plug-in-Gaitmodel

References:

1. BiddissEAandChauTT.Upperlimbprosthesisuseandabandonment:Asurveyofthelast25years.ProsthetOrthotInt2007;31(3):236-257.

2. DamsgaardM.,etal.AnalysisofmusculoskeletalsystemsintheAnyBodyModelingSystem.SimulModelPractTh2006;14(8):1100-1111.

Title: Apreliminarystudyoncharacterisationoffingerinterfacekineticsusingapressureandshearsensorsystem

Presenter: NicholasHale,PhDStudent

Address: EngineeringandtheEnvironmentUniversityofSouthamptonHighfieldSouthamptonSO171BJ

Tel: 02380-598746


OtherAuthors

MariaValero,JinghuaTang,MichaelMcGrath,PiotrLaszczak,JianlingGao,DavidMoser,LiudiJiang–UniversityofSouthampton

Introduction:Activeprosthetichandscouldbenefitfromtactilefeedbackatthefingerswhenperformingavarietyofdailyactivities,suchasgraspingandmanipulatingobjects.Thisrequiresreal-timemonitoringofpressureandshearattheinterfacebetweenthefingersandobjects.Althoughsomepressuresensorsareavailable,littleworkhasbeenreportedonsensorsystemscapableofsimultaneousmeasurementofpressureandshear,despitethefactthatshearmonitoringiscrucialindetectingobjectslipandmovement1.Anoveltri-axialpressureandshearsensorsystem(TRIPS)hasrecentlybeenreportedtobeapplicableatthecriticalresiduum/socketinterfaceforlowerlimbprosthetics2.ThispreliminarystudyaimstoexpandthepotentialapplicationsoftheTRIPSsensorsystemtoupperlimbs,inparticular,bymonitoringdynamicloadsatfinger/objectinterfaceduringtypicalobjecthandlingtasks.

Method:BaselinecalibrationsfortheTRIPSsensorsystemwereconductedinresearchlabsettingsusingspecificallydesignedtestprotocols.Synchronousfunctionoffivesensorswasstudiedindetail.Subsequently,uptofivesensorswere attached to the finger phalanges of a healthy participant’s hand. The participant performed typical dailyinteractivetasks,suchasgrasping,holdingandmanipulatingobjects.Real-timepressureandshearvaluesatvariousphalanxlocationsandfingerdigitswereobtainedandanalysedasafunctionoftheseactivities.

Result:Peakvaluesofpressureandshearwerereportedandcomparedwithresultsinliterature.Thesepressureandshearvaluesasafunctionoftimeprovidecharacteristickineticinformationassociatedwithmanipulationofobjects.Sensoroutputsatdifferentanatomicallocations,i.e.theproximal,intermediateanddistalphalangesrespectively,alsogivesomeindicationsofnaturalhandmovementcharacteristics,includingflexionandextensionofthetendons.The initial resultssuggestthatthedevelopedTRIPSsensorsystemcouldbeusedathand/fingerinterface for dynamic load feedback. As such, the system could be potentially exploited in various areas, forexample, to assess rehabilitation outcomes for stroke patients, to assist design and provide load feedback forprosthetichands,andtoprovideinputforrealtimesimulationofupperlimbdynamicfunctions.

Conclusion:ThisstudyprovidespreliminaryevidencethattheTRIPSsensorsystemcouldbeusedattheinterfacebetweenfingerandobjecttomonitordynamicchangesinpressureandshear.Thepotentialapplicationscouldbefurther expanded to areas in studies of upper limb functions, advanced prosthetic development, and assistivetechnologiesforrehabilitation.

References1.KappassovZ,CorralesJandPerdereauV.Tactilesensingindextrousrobothands-Review.RoboticsandAutonomousSystems.2015;74:195-220.

2.LaszczakP,JiangL,BaderDL,MoserDandZahediS.Developmentandvalidationofa3D-printedinterfacialstresssensorforprostheticapplications.MedEngPhys.2015;37:132-7.

Title: ValidationofAnyBody™modelkinematicsforcharacterisingprosthesisfunctionalusage:acomparisonwithVicon®Plug-in-Gaitmodel

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Title: SeriousgaminginlearningtouseaprostheticdevicePresenter: RaoulMBongers,UniversityMedicalCentre,CentreforHumanMovementSciences,

Groningen,TheNetherlandsE-mail: r.m.bongers@umcg.nlTheuseofcomputerenvironmentsorcomputergameshasgainedpopularity inrehabilitationlately.Alsointherehabilitationofprosthesisusetheemploymentofcomputergameshasincreased;companiesprovidewiththeirprosthesissimpletraininggamesforthemyosignalsandseveralgamesforlearningtocontrolthemyosignalhavebeeninvestigatedintheliterature.Thecurrentpaperconcentratesonseriousgamesthataregamesofwhichthemaingoalisnotsimplyentertainmentbuttoprovideasituationinwhichausercanlearncertainskills.Thecurrentpaperfocusesonapplyingsuchgamestoimproveaction-perceptionskillstocontroltheprosthesis.Thepapers’goalistogiveabriefoverviewofthegamesproposedforthosepurposes.Thisoverviewwillbetakenasastartingpointtothinkabouthowtoinvestigatetheeffectofseriousgamesforprostheticrehabilitation.Usingourownresearchwewillshowthedifficultyindevelopingappropriateseriousgamesforprostheticrehabilitation.Thesedifficultieswillbeputinabroaderperspectiveonrehabilitation.Thatis,itwillbeshownthattheproblemsfindingaseriousgame for which the developed skills transfer to prosthesis use provide general insight into how to developrehabilitation training. The paper will finish with a proposal of how to proceed with developing rehabilitationtrainingforprosthesisuseandespeciallyforusingseriousgamesforthat.Itwillbearguedthattheprimaryfocusshouldbeontheaction-perceptioncouplingscharacterizingtheprostheticuse,and,second,itwillbearguedthattodevelopatrainingitisrequiredtofocusontheprocessesthatrepresenttheevolvingofaskilloverlearning.

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Title: Patient’sperceptionsofupperlimbprostheticsandhowvirtualrealitymaybe usedinclinicalpracticePresenter: CarolGarcia,SeniorPhysiotherapyLecturer&TeamLeaderPhysiotherapist,

FacultyofHealth&Wellbeing,SheffieldHallamUniversity,Sheffield,UKE-mail: [email protected] limbprosthesisnon-use rates arequitehighand thisnon-usehasbeenattributed to a rangeof factors,includinguseracceptanceoflimbloss,amismatchbetweentheprosthesisandexpectations,gender,ageatfitting,andlifestyle.Thusinordertofacilitateusersatisfactionthereneedstobeagoodmatchbetweenthespecificneedsand expectations of the individual and the type of prosthetic chosen. However, establishing this match is achallenge,sinceuntilausertriesoutaprosthesisitisdifficultforthemtofullyunderstandwhatitmightlooklikeandhowitmightfunction.

Virtualrealityoffersanopportunityforuserstotryoutprosthesesaspartoftheprocessofmatchingtheprosthetictotheirindividualneedsusinga‘trybeforeyoubuy’approachwiththeultimateaimofbeingabletobetterinvolveusersinthedesignofnewprosthetics.

Thepresentationwilllookatpatient'sperceptionsoftheirexperienceofprostheticuseandprescriptionandthenhowvirtualrealitymaybeusedinordertopotentiallyfacilitateamatchbetweenuserexpectationsandprescriptionandthefutureuseofVRinthefieldofupperlimbprosthetics.

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Title: Simulatedgrippingofanobjectwithareal-timemusculoskeletalmodelofthehand:applicationtoprosthesiscontrol

Presenter: EdwardKChadwick,LecturerinBiomedicalEngineering,Dr.

address: GuyHiltonResearchCentre,ThornburrowDrive,Stoke-on-Trent,ST47QB

Tel:

Email:

01782674423

[email protected]

Otherauthors: DrDimitraBlana,InstituteforScienceandTechnologyinMedicine,KeeleUniversity,UK.DrAmartyaGanguly,Post-doctoralResearchAssociate,InstituteforScienceandTechnologyinMedicine,KeeleUniversity,UK.ProfAntonieJvandenBogert,ClevelandStateUniversity,Ohio,USA.ProfWendyMMurray,NorthwesternUniversityandtheRehabilitationInstituteofChicago,USA.

Objectmanipulation is an important goal for upper limb prosthesis users. Increasingly sophisticated prostheticdeviceshavebecomeavailableoverthelastfewyears,butthedifficultyinprovidingsophisticatedcontrollimitsfullexploitation.Thelong-termgoalofourworkistoenablesimultaneous,continuouscontrolofmultipledegreesoffreedom (DOF) to facilitate natural performance of complex tasks. We have proposed the use of a real-timemusculoskeletalmodelasacontrollerforaprostheticdevice1wherebycontrolsignalsfromtheusercanberecordedfromresidualmusclestodriveadynamicsimulationofhandmotion.Theresultingmodelledfingeractionscanbereplicatedbytheprosthesis,givingnaturalmovements.Inthispaperwedemonstratehowsuchamodelcouldbeusedtocontrolgripforceinasimulatedprosthetichand.ThemusculoskeletalmodelofthehandisbasedonHolzbauretal.2andcomprises24DOFand26muscles,eachmodelledwithactivationdynamicsanda3-elementHillmodel.Themuscledynamicsandequationsofmotionwerecombinedintoasetofimplicitfirst-orderdifferentialequationswith100statevariablesand26controlinputsintheformofneuralexcitationstothemuscles.Theforward-dynamicmodelwasusedinsimulatedclosed-loopcontrolofgripping,wheretheobjectwassimulatedbyaforceappliedtothetipsofthefingersinthemodel.Fingertipforceswerefedbacktothemodelandthegripforce(justpreventingslip)modulatedbycontrollingmuscleexcitationsofthedeepflexormuscles.Theelbow,wristandthumbwere locked,with50%of theweightbeingevenlysharedbetweenthefourfingers.MuscleexcitationswerecontinuallyupdatedbyaPDcontrollerwithproportionalgainKP=0.01N-1 and derivative gain KD=0.0005N-1. The controller was tuned to give a short rise time and minimaloscillation.Theforward-dynamicssimulationwasabletoruninrealtimeonnormaldesktophardware,witha5smovementbeingsimulatedin4.3s.Theinitialplacementofthecupinthehandcreatedastep-inputforthesystem,andthegripforceincreasedtopreventslipwithin35ms,reflectingthetime-delaysinmuscleactivation.Abriefoscillatoryresponseinthemuscleactivationsisseen,butdiminishesafter~0.4s.Fromthenonthecontrollermaintainsthemuscleactivationsattherequiredleveltoensurethatthecupdoesnotslip.Thedynamicsofthehandmodel,includingmuscleactivationdynamics,tendoncomplianceandparallelelasticforcecomponents,naturallyleadtoahuman-likecompliantgripwhenusedaspartofacontroller.Humangrip,however,ischaracterizedbyasignificantanticipatorycomponentasthedelaysinfeedbackaresignificant(~100ms).Inthisexample,wehaveassumedanautonomouscontrollerembeddedwithintheprosthesisandsohavenotincludedthe feedforward component or the feedback delays. However, a model-based approach, when combined withimprovementsinperipheralnerveinterfacing,willallowthedeliveryoffeedbacksignalsrepresentingmuscleforceandlengthtotheusertogiverichhapticandproprioceptiveinformationonprosthetichandfunction.1. BlanaD.etal.XVInt.SymposiumonComputerSimulationinBiomechanics,2015.2. Holzbaur,K.R.S.etal.AnnBiomedEng,33(6),829–840,2005.

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Title:Amultimodalimmersivehapticvirtualrealitysystemfortherehabilitationofphantomlimbpaininupperlimbamputees Presenter:PeterSnow,PhDStudent,Mr ContactAddress: RoyalNationalOrthopaedicHospital

StanmoreMiddlesex HA74LP

ContactEmail: [email protected] Other Authors: Dr Imad Sedki, Consultant in Rehabilitation Medicine, Prosthetic

RehabilitationUnit,RoyalNationalOrthopaedicHospital,Stanmore.

Dr Marco Sinisi, Consultant Neurosurgeon, Peripheral Nerve Injury Unit, Royal National

OrthopaedicHospital,Stanmore. Dr Rui C.V. Loureiro, Engineer, University College London, Royal National OrthopaedicHospital,StanmorePhantomLimbPain(PLP)isawellknowneffectpostamputationwithintheamputeepopulation.TheacuteandchronicpainsufferedfromamputeeswithPLPhasadetrimentaleffectontheirdailylives made worse by the various treatment options and the various success rates of thesetreatmentoptions.OnetreatmentoptionavailableismirrorboxtherapywhichhasbeenshowntohaveaneffectinsomeamputeesinreducingPLP,howeverthistendstobemoreshorttermrelive.This isduetotheamputeeembodyingthevisualmirrorimageoftheirintactlimbwheretheiramputatedlimbislocated.Employing tactile feedbackhasbeenshown to reinforceembodimentofavisual imagewithin the non amputated population. Which has lead to research in using TMS to providetargetedfeedbackbacktotheCNStoallowamputeestofeelobjectstheyareholdingontowiththeirprostheticlimb.We have developed a multimodal immersive sensorimotor system that facilitates retraining ofsimple manipulation tasks. Users are able to perform motor tasks using our immersive hapticsensorimotortrainingsystemthatprovides,directphysicalcontacttothehapticdevice,mappingofthe information from the device to the virtual representation of the physical limb, and anapplication thatmaintainschallengeand interest to the individual.Basedon theseelements, thehaptic system acquires EMG commands, residual limb kinematics and displays the combinedresidual limb movements in a virtual reality environment that includes force-based interactionswithvirtualobjects.Visualisation isprovidedviaaHeadMountedDisplay soas to facilitate first-person view of the virtual environment and embodiment of the residual limb with the virtualrepresentation.Our ongoing clinical pilot study taking place at the Royal National Orthopaedic Hospital,Stanmore,willestablishamoresolidscientificframeworkforadvancingtheknowledgeofhapticinteraction in the treatment of Phantom Limb Pain and its outcome will be used to inform afuture phase II trial to quantify the new approach in terms of cost benefit and therapeuticpractice. The proposed paper presents the design of the system and initial results from ourclinicaltrial.

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Title: AssessingVariabilityinLowerLimbProstheticSocketFabrication

Presenter: DrA.S.Dickinson,RAEngResearchFellow

Address: 5/2003,FacultyofEngineeringandtheEnvironment,UniversityRoad,Southampton,SO171BJ

Tel:02380595394 E-mail:[email protected]

OtherAuthors:

MrMO’Byrne,Prosthetist,OpcareLtd;DrPRWorsley,Lecturer,UniversityofSouthampton

Background and Objective: In assessment of prosthetic socket fit, it is important to consider all sources ofvariabilityfromresiduumshapecapturethroughtoprostheticlimbassembly,adjustment,anddonning.Therangeof overall accuracy in central fabrication facilities has been investigated for transtibial sockets [1], with theindividual error contributions of carving and forming processes [2], but there has been less research into thesensitivityofprocessvariables.Thisstudypresentsanupdatedprotocoltoquantifyfabricationprocessvariabilityincorporating external and internal surface scanning. We then illustrate how sensitivity to fabrication processparametersmaybetested,usinganexampleofoventemperature.Methods:Ninenominallyidenticaltransfemoralsocketmalemouldswerecarvedin80kg/m3polyurethanefoamonanORTIScarver(Roboticom,Italy).Thesewereusedtoproduceninesocketdrapes.Threevacuumdrapeswereproducedusing12mmpolypropylenesheets(NorthSeaPlastics,UK)pre-heatedinathermoplasticconvectionoven(North Sea Plastics, UK) at each of three temperatures: 210°C (mid-range manufacturer-recommendedtemperature,200-220°C),195°C (low)and225°C (high).Beforedraping, the foammouldwasdigitisedusinganOmegascanner(OhioWillowWoodCompany,USA).Theinternalsurfaceofthedrapedsocketswasscannedaftermouldbreak-out,following12hrcooling.Thepairsofsurfacescanswerethenprocessedbyapreviouslypresentedcomputationaltechnique.The.stlfileswereimportedintotheMATLABmodellingenvironment(Mathworks,USA)andalignedtoastandardcoordinatesystem. Each drape andmould scan pairwas registered so that the location of corresponding points could becompared.Finally,thesurfaceheightdeviationbetweendrapesandmouldswasquantifiedandpresentedusingcolourmaps,withthevolumeandwidthprofiles.ResultsandDiscussion:Allninedatasetpairsshowedthesametrendsofdrape-moulddeviations,notablyspring-backaroundtheconcaveischialbrimfeatures,interferenceonthemedialwall,andaslightreductioninconvexdistaltipradius.Quantitatively,overthesurfaceareaofthefinalshape,theaveragesurfaceheightdifferencebetweendrapeandmouldpairswasbetween0.18mmand0.38mminterference.Asameasureofvariability,thestandarddeviationofsurface height difference was between 0.73mm and 1.17mm, approximately two- to four-times the range ofscanneraccuracy.Nocleardifferenceswereobservedbetweentheresultsobtainedacrossthetestedtemperaturerange,althoughtherewasasmallreductioninsurfacevariabilityforthehighesttemperature(S.D.of0.82mmat225°Cvs.0.91mmand0.95mmat210°Cand195°C,respectively).Overalldeviations inwidthandvolumeweresmall.Grossmeasuresshowedhighconsistency,butitwasobservedthattheobtainedsurfacedeviationmapresultswerehighlysensitivetothealignmentoftheshapedatasets,andmarkedlydifferentdeviationpatternsresultedfromdifferentalignmentstrategies.ConclusionsandImplications:ThisstudypresentsanupdatedmethodwherebythemainsourcesofvariabilityinCAD/CAMsocketfabricationcanbemeasured,andkeyprocessparametersidentified.Toillustratethis,anexampleofdrapeoventemperaturewasused,andwasshownacrossthemanufacturer-advisedrangetohavelittleeffect.Aconventionforalignmentshouldbeagreed,andadditionalworkshouldinvestigatefurtherprocessvariablesandtheclinically-requiredlevelofsocketaccuracy.References:

1. Sanders,Rogers,Sorenson,LeeandAbrahamson,CAD/CAMtranstibialprostheticsocketsfromcentralfabricationfacilities:howaccuratearethey?JRRD2007;44(3):395-406.

2. SandersandSeverance,Assessmenttechniqueforcomputer-aidedmanufacturedsockets.JRRD2011;48(7):763-774

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Title: ComparisonofSubjectsUsingPurelyMechanicalHipDisarticulation/HemipelvectomyLimbstoThoseUsingHydraulicandMicroprocessorLimbs.

Presenter: ElenaHarrisProsthetist

Address: WESTMARCQEUH Tel:01412011851

1345GovanRoad E-mail:[email protected]

Glasgow,G514TF

Otherauthors: ScottishSpecialistProstheticsService.

Named: HelenScott/NicolaPorteous/CatrionaMawdsley

AimsandObjectives:Historicallythehipdisarticulation/hemipelvectomyamputeehasbeenachallengetofitinrelationtocomfort,successfulgaitoutcomesandlongevityofuse.Theintroductionofhydraulichipjointsworkinginconjunctionwithmicropossessorkneeunitshascreatedanewpossibilitythattheuserandprosthetistcouldbemore successful in these areas. The evidence supporting the use of this state of the art technology is limited.Therefore,thepurposeofthisstudywastofitexistinguserswithahelixhipjointandC-legmicro-processorkneeunitandcomparetheresultswiththeirpreviousmechanicallimb.

Subjects:1femaleand2malehipdisarticulationamputeeswererecruited.Thefemalesubjectpreviouslyuseda7E7hipjointand3R36kneewitha1D35foot,andnowusesahelixhip,c-legandtritonfoot.Eachmalesubjectpreviouslyuseda7E7hipjointwithoneusinganOFM2kneeandtheotherusinga3R36kneeand1D10feet.Bothweregivenhelixhipjoints–onemaleusesac-leg3andtheotherac-leg4–bothhavetritonfeet.

Methods:Threesubjectswereaskedtocompletevarioustasksandquestionnairesusingtheirpreviousprescriptionandnewstateoftheartlimb.Threeobjectivemeasureswererecorded:theamputeemobilitypredictor(AMP);the2minutewalktest(TWT);andtheL-test.Threesubjectivemeasureswerealsotaken:theEQ-5d,theTAPES-revisedandtheActivitiesBalanceconfidencescale(ABC).Measureswererecordedat3and6monthsafternewprescriptionwasgivenandcomparedtopreviouslimb.

Results:Allsubjects’objectivescoresimproved.TheAMPincreasedforallby3pointswithamaximumK-levelof4andminimumof3.The2TWTshowedameanincreaseof30metresandthemeanincreaseintheL-testwas2.5seconds.

Thesubjectiveresultsalsoshowedimprovements.TheEQ-5D,andTAPES-Rresults,improvedforallbutonesubjectwhoremainedthesamewithherstateoftheartlimb.AllsubjectsABCconfidencescalesimprovedwithamaximumincreaseof50%.

Conclusionsandrecommendations:Preliminaryresultsshowthatthehydraulichipandmicro-processorkneedohavethepotentialtoprovideaddedbenefitstouserscomparedtomechanicaljoints.Furtherinvestigationintotheseparateeffectsofthemicro-processorkneeandhipwouldbeofinterestwithalongertimeframeandgreaternumberofsubjects.

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Title: Gon(y)algiaparasthetica/Saphenousneuralgia:MasqueradingasResiduallimbpain

Presenter: DrA.Boppana,ST6RehabilitationMedicineTrainee&TraineeRepresentativeWestmidlandsDeanery,WMRC,91OakTreeLane,SellyOak,Birmingham,B296HZ

Tel: 01214663228


OtherAuthors: DrP.R.HolavanahalliConsultantAmputeeRehabilitationmedicine,WMRC,Birmingham.MrMCirasConsultantRehabilitationMedicine,HaywoodHospital

Background:Saphenousneuralgia/gon(y)algiaparastheticaisanuncommonpainfulconditioniscausedbyirritationorcompressionattheadductorcanalorelsewherealongthecourseofthesaphenousnerve.

It isanimportantdifferentialdiagnosisofanteriorkneepain.Itcansimulateotherpathologyinkneelikefore.g.meniscaltears,Osteoarthritis,patellartendinopathyetc.

Clinicaldetails:A50yroldladywithspinabifidaunderwentbilateralbelowkneeamputationattheageof11yrs,andsincethenhasbeenabilateralprostheticuser(PTBwithsiliconeliner).shepresentedtoclinicwithburningpaininleftresiduallimballalongtheanteromedialaspectofkneeandtheshin,(scoring9-10/10onnumericalpainscale) for the last 6months, andunable towear theprosthesis fornot more than45mins. Shehasnoothersignificantmedicalorsurgicalhistory.Diagnosis & Management: On examination, Skin over the area was normal.She had Tenderness/ Tinel’s signpositivealongthesaphenousnerveinthemiddlethirdofadductorcanal,andhasrespondedpositively(Painscore0/10)toLocalanaestheticnerveblock(2.5%Chirocaine).Patientisnowawaitingasteroidinjectionasafirststageoftreatment.Withregardstomanagingthecondition,welookedintomedicalliterature;whereinthecasereportsdomentionaboutthebenefitofsteroidinjectionandphenolnerveablation.Similarlyour recent study,a case seriesof17patients (all cases from July2011– June2014&non-amputees)diagnosedwiththeconditionwhohavehadeithersteroidinjectionorphenolnerveablation,havedemonstratedthebenefitsnotonlyintermsofimprovedpainscores,butalsoimprovedfunctionofthekneeandqualityoflife.

In our study we looked in to the outcome/ efficacy of saphenous nerve block secondary to saphenousneuralgia/Gon(y)algiaparasthetica

OurstudyResultswereasfollows(inbrief):Totalof18caseswereidentifiedin17patientswhometthecriteria,themeanage56.52yr’s,meantimesincetheyhadtheinterventionwas17months,andtheComorbiditiesincludeMultiplesclerosisin2patientsandkneeproblemsin9patients.Fourdifferentmethodswereusedforcarryingouttheperineuralinjection/nerveablationprocedure(blind,Ultrasoundguided,Nervestimulator/locaterguidance,USS+Nerve stimulator/locaterguided). Post injectionwenoticed improvement inpain scores (Numericalpainscale)in76.6%,functionofknee(OxfordkneeScore)improvedin53%ofcases,andtherewasalsoanimprovementinQualityoflife(SF36).Wefoundnostatisticallysignificantdifferencebetweenthemethodsonpain(Pvalue=0.57)orkneefunction(Pvalue=0.59).

Implications/recommendations:Saphenousneuralgiaisuncommonlyseeninamputeesbutnonethelessit isanimportantdifferentialdiagnosis for residual limbpainandasAmputee rehabilitationspecialist’sweneed tobeawareofthecondition.

We recommend, Palpation of the saphenous nerve should be part of routine examination of every patientpresentingwithresiduallimbpain.

80

Title: CharacterisationofLowCostCAD/CAMScanners

Presenter: A.S.Dickinson,RAEngResearchFellow,Dr

Contact

Address:

5/2003,FacultyofEngineeringandtheEnvironment,UniversityRoad,Southampton,SO171BJ

Tel:02380595394 E-mail:[email protected]

OtherAuthors: DrP.R.Worsley,Lecturer,UniversityofSouthampton

BackgroundandObjective:CAD/CAMtechnologymayprovidebenefitsinprostheticsocketdesignandfabricationbyenablingaquantitativeprocess,improvedconsistencyofshapecaptureandfabrication,andincreasedpatient-facingtimeforclinicians.Lowercostalternativescanningtechnologyhasbeenproposedforuseinprosthesisandorthosis(P&O)production,andthisstudysetouttoevaluatetheaccuracyandrepeatabilityoflowcostscannersincomparisontoclinicalstate-of-the-artsystems.Methods: Twoanalogueobjectswere scanned, representingprosthetics andorthotics scenarios: a 3D-printedmodelrepresentingatranstibialamputationresiduallimb,andafootcosmesis.Fiverepeatscansofeachobjectwere takenusingaCreaformGo!SCAN (ScannerA,equivalent to clinically-usedOMEGAScanner), a3DSystemsSense(ScannerB)andaniPad-mountedStructureSensor(ScannerC).Thesurfacescanswerethenprocessedbyapreviouslypresentedcomputationaltechnique[1].The.stlfileswereimportedintotheMATLABmodellingenvironment(Mathworks,USA),aligned,andregisteredtoa‘baseline’shape:the3Dprinterfilefortheresiduumanalogue,andthefirstGo!SCANfile,forthefootcosmesis.Thevariationinsurfaceheightbetweengroupsof5scanswascalculated,andthedeviationbetween3Dprintfileandscanfileswascalculatedfortheresiduumanalogue.ResultsandDiscussion:Indicatingaccuracy,scannersA,BandCshoweda95thpercentilesurfaceheighterrorvs.the 3D print file below 0.31mm±0.17, 2.44±0.78 and 4.07mm±1.32, respectively (average of 5 scans ± S.D.).Indicatingvariability, thethreescannersshoweda95thpercentilesurfaceheighterrorvs. themeanof5scansbelow0.14mm±0.10,0.69mm±0.36and1.16mm±0.76.Forcontext,thevariabilityofrectificationinplastercastinghasbeenreportedas1-2mmonaverage,andupto4.3mmmaximum,inatwoprosthetiststudy[2].Comparedtopreviousresults[1],ScannerAperformedconsistently.Usingamorepowerfulcomputer,ScannerBprocessedthescandatafasterandthusacquiredashapemorepracticallyreliably(i.e.withoutlossoftracking)butshowedsomewhathighersurfaceheighterrorandvariability.Inspectionofcolourmapsofthedistributionoferrorindicatedwheresurfaceerrorsmaybecorrected.ScannerCproducedrelativelyuniformlyover-sizedshapeswhichcouldpotentiallybere-scaledusingaphysicalmeasurement.Thestudy’smainlimitationsareuseofnon-living,staticanaloguescanningtargetsratherthandirectscanningofpatients.Furthermore,ScannersBandCwereusedwithnon-P&O-specificsoftware.ForP&Ouse,anOMEGAScanapp (OhioWillowWoodCompany)hasbeendeveloped forScannerC,and thiswillbeassessed in futureworkalongsideadditionallowcostdevices.ConclusionsandImplications:ThisstudypresentspreliminarydataforevaluatingandselectingoptimalscanninghardwareforCAD/CAMP&Odeviceproduction.ThesuperioraccuracyandconsistencyoftheGo!SCAN/OMEGAscanneroverlowercostdevicesisclear.Additionalworkshouldmonitorthefastdevelopmentofnewsystemsandinvestigatetheclinically-requiredlevelofscanneraccuracy.References:

1. Dickinson,Steer,WoodsandWorsley,Registeringamethodologyforimagingandanalysisofresidual-limbshapeaftertranstibialamputation,JRRD2016;53(2):207-218.

2. Convery, Buis, Wilkie, Sockalingam, Blair and McHugh, Measurement of the consistency of patellar-tendon-bearing castrectification,POI2003;27:207-213.

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Title: Patternsofbonydeformityfollowingtranstibialamputationduetosepticaemia.

Presenter: MGeada,Prosthetist,StanmoreDSC,RNOH

Address

OtherAuthors: MMcAlinden,ClinicalLeadProsthetist,StanmoreProstheticRehabilitationUnit,RNOH;DrD Hoad, SpR, Stanmore Prosthetic Rehabilitation Unit, RNOH; Dr I Sedki, Consultant inRehabilitationMedicine,StanmoreProstheticRehabilitationUnit,RNOH;MrPeterCalder,Consultant Paediatric and Limb Reconstruction Surgeon, RNOH; Professor R Hanspal,ConsultantinRehabilitationMedicine,StanmoreProstheticRehabilitationUnit,RNOH

Introduction: It is recognised that, following meningococcal septicaemia, there is epiphyseal growth platedisturbance.Bradishetal.(2011)havedescribedthedeformitiesandtheirmanagement.However,inpeoplewhohavehadanamputation,thesedeformitiesarelikelytoaffectprostheticrehabilitation.

Methods:Thisstudyisaretrospectivereviewof6transtibialamputees(9amputations)beforetheageofskeletalmaturity,whohadanamputationfollowinglifethreateningsepticaemia.Therewere3boysand3girlswithagesrangingfrom4to14years.AllchildrenwereunderregularreviewandfollowupfortheirprostheticmaintenanceandrequiredX-raysbecauseofobviousphysicaldeformitiesandassociatedsymptoms.AllX-rayswerereviewed.

Results: Only one child with bilateral trans-tibial amputations showed no significant epiphyseal growth platedisturbancebuthadbonyovergrowthrequiringrevisionsurgeryinbothhisresiduallimbs.Healsoshowedfusionofthedistalendofthetibiawiththefibula.Allotherchildrenshowedsignificantgrowthplatedisturbancewithprematureclosureofthetibialepiphysealgrowthplateassociatedwithovergrowthofthefibula.Notably4childrenshowedthattheprematureclosureofthephysiswasonthemedialsideleadingtoavarusdeformity.Onechildhadfusedepiphysisintheantero-medialaspectleadingtoavarusdeformityassociatedwithgenurecurvatum.Allhadpartialarrestoftibialgrowthonthemedialsideandassociatedovergrowthofthefibula.

Discussion:Thereseemstobea remarkableconsistency in thepatternof thedeformity thatdevelops in thesepatientsandthishasnotbeenrecognisedinpreviouslypublishedliterature.Wesuggesttwopossiblereasonsforthis:

• Sincetheepiphysealgrowthplatedamageseemstooccuronthemedialside,thismaysuggestthattheanatomyofthevascularsupplymaymakethemedialsideofthegrowthplatemoresusceptibletodamage.

• Anotherhypotheseswouldbetheconsequenceofthe‘Wolff’sLaw’thatstatesthatboneadaptstotheload that it is subjected to and the ‘Hueter-Volkmann Law’ that proposes that growth is retarded byincreasedmechanicalcompression(StokesI.A.F.,2002)andacceleratedbyreducedloadingincomparisonwithnormalvalues.AllX-raysshowedavarusdeformitytosomedegreeandthatwouldhavesubjectedthemedialsideoftheepiphysestogreater load leadingtoprematureclosureofthemedialsideofthephysis.Thismayalsoexplainwhyonepatientdidnotshowepiphysealgrowthdisturbanceashewaslargelydependantonhiswheelchair forhismobilityanddidnot loadhisknees.Onewouldof courseneed tomonitorhisbonydevelopmentashismobilitywithprosthesesprogresses.

Conclusion:Theimportanceofrecognisingthegrowthplatedisturbanceandthesubsequentpatternofdeformityasdescribedaboveistoassistinprostheticsocketfitandmaintenance.Thiswillhelpidentifytheneedforregularassessmentsandforplanninganysurgicalintervention,ifandwhenrequiredtoassistprostheticmobility.

References:

1.BradishCF,ParkDH,Themanagementoftheorthopaedicsequelaeofmeningococcalsepticaemia:patientstreatedtoskeletalmaturity.JBoneJointSurfBr.2011

2.StokesI.A.F.,Mechanicaleffectsonskeletalgrowth.JMusculoskelNeuronInteract2002

Tel:02089095505

Fax:n/a

Email:[email protected]

StanmoreProstheticRehabilitationUnit

RoyalNationalOrthopaedicHospital

BrockleyHill-Stanmore

HA74LP

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Title:

Equippingtherapiststorehabilitateamputeespostsuddenonsetnaturaldisaster–BACPAR’s(BritishAssociationofCharteredSocietyofPhysiotherapistsinAmputeeRehabilitation)collaborationwithHandicapInternationalUK

Presenter: MJCole,Physiotherapist,Mrs

Address: SchoolofRehabilitationSciences,FacultyofHealth,SocialCareandEducation

StGeorge's,UniversityofLondonCampus,CranmerTerrace

London

SW17ORE

OtherAuthors: PeterSkeltonMSc,MSCP

Background - Since 2013 BACPAR has been working with Handicap International (HI) to train rehabilitationprofessionals as part of the UK Emergency Medical Team. Following training, rehabilitation professionals withappropriateskillsareselectedtojointheUKTraumaRegisterandtrainaspartofasmallmulti-disciplinaryteamtodeploypostdisaster.TheUKTraumaRegisterwasestablishedtofacilitatethedeploymentofsurgicalteamsfromthe UK to sudden onset disasters overseas and traditionally therapists had not been included in medicalhumanitarianresponseteams.Recentresearchandbestpracticeguidancehasplacedrehabilitationprofessionalsattheforefrontoftheemergencyresponse.HIUKwasawardedfundingfor2yearsfortrainingpurposes;fundinghasbeenextendedforafurther5.HIcontinuestoworkwithseveralUKPhysiotherapyprofessionalnetworks–includingBACPAR– to trainanddeliver training to therapistson the registerappropriate for thehumanitariancontext.

Aim-Thedevelopmentanddeliveryoftheoretical,practicalande-learningmodulesaimstoequiptherapistswithrelevantspecialistknowledgeandskillstomanagepeopleacquiringamputationfollowingsuddenonsetdisaster.

Method - Under the guidance of HI, BACPARwas taskedwith developing and delivering 3 amputee specificmodulestotherapists.Thecoreamputeerehabilitationtrainingmodulefocusesonacutemanagementincludingpre-amputation, perioperative and pre-prosthetic phases. Participants complete a post core trainingselfassessmentandattendatop-upworkshop(practicaltrainingmodule)todevelopconfidenceandcompetencewithpracticalskillsasrequired.Ane-learningmodulesupportandcomplementspriorlearning,advancingtheoryinkeyareasinanemergencycontext.

Results-Therehasbeenaencouragingresponsewithapproximately150UKtherapistsjoiningtheregisterbyJune2016ofwhichapproximately10arespecialisedinamputeerehabilitation.8coretrainingmodulesand6amputeerehabilitation workshops have been delivered up to now. Feedback has been positive to module content anddelivery.Thee-learningmoduleisaccessibletoallregistrants.Todatetherehavebeen4short-termdeploymentsinvolvingapproximately30therapistswhohavereceivedtraining.

Discussion&Conclusion - “Early rehabilitationcangreatly increasesurvivalandenhancethequalityof life forinjured survivors.1. The collaboration between HI and BACPAR is preparing therapists for deployment in thesituation of a sudden disaster and reflects the movement towards increasing professional standards inhumanitarian response. The uptake of therapists on the UK Trauma Register is encouraging and feedback ontraining is positive. The experience of therapistswhohave been deployed post sudden onset disaster is to beresearchedandtheappropriatenessofthetrainingmoduleswillbeexplored.

References:1.TheSphereProject.HumanitarianCharterandMinimumStandardsinHumanitarianResponse.ThirdEdition2011.www.sphereproject.org

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GeorgeMurdochPrizeLecture

Title: Thedevelopmentofbiomimetichydraulicself-aligninganklesforlowerlimbamputees

Presenter: DrDavidMoser,HeadofResearch,BlatchfordGroup,Basingstoke,UK


The roleof research is toaskand seekanswers toquestionsand to continuously re-evaluate theanswers (i.e.questionwhatwethinkweknow).Inthecaseofamputeesthismeanscontinuouslyevaluatingandunderstandinghoweffectivelytechnologymeetsthedemandsofdailyactivities.IntheO&Pfieldthereisnoshortageofquestionstoaskandmanyanswershavebeenproposedwhichwithre-examinationmaynolongerbedeemedvalid.

Bioengineersovermanyyearshavecomeupwithmanyvarieddesignsolutions forprosthetic feetbasedonascientificunderstandingofthenaturalfootstructureandbehaviour.Thesesolutionshaveinevitablyevolvedovertheyearsasunderstandinghaschangedandasnewtechnologieshaveemerged.Understandinguserneedsisnotonlyattheforefrontofboththeresearchanddesignactivity, it isfundamentally integratedwithintheprocesswhichmakestechnologydevelopmentinthefieldexceptional.Stilltodaytheissueofsocketfitandlimbalignmentcan cause issues which profoundly affects limb performance and capability, particularly on uneven groundimpactingtheuser’scomfortandconfidence.

ThislecturereportstheobservationsofoveradecadeofR&Dandclinicalstudieswhichledtoanewgenerationofbiomimetic prosthesis which have a self-aligning capability, culminating in the commercialisation of the firsthydraulicanklesforlowerlimbamputees.Measurementofoutcomesmustbetheguidingprincipletoanyresearchwork,informingprogressbutalsostimulatingnewavenuesofinvestigation.Futurechallengesincludeissuesaroundaccessibilitytomoreadvancedtechnology,education,keepingpacewithscienceandbuildingupandreportingthescientificandoutcomesevidencebaseasitcontinuestogrow.

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ABSTRACTS-Saturday1October–ProstheticsStream(inorderofpresentation)

Title: TargetedMuscleReinnervation:UKexperiences

Presenter: MrNorbertKang,ConsultantPlasticSurgeon,RoyalFreeHospital,London,UK


Targeted Muscle Reinnervation (TMR) provides a powerful new tool for improving the control of a prostheticlimb.However,itcanalsohaveanun-intendedbutpowerfulbeneficialside-effectofimprovingpainsymptomsduetoneuromasandphantomlimbinalargeproportionofamputees.ThereisnoformalTMRprogramintheUKbecause(sofar)ithasproveddifficulttojustifyperformingtheprocedurewhentheNHSisunabletofundeithertherehabilitationorprosthesisthatshouldnaturallyfollowafterthesurgery.Nevertheless,webelievethattheprocedure can be justified on the basis of symptom improvement alone and hope to present the evidence tosupportthisview.

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Title: OutcomesandChallengesofFittingMicroprocessorControlledKnees:A6MonthReviewPresenter: LauraBrady,Prosthetist,MissContact WestMARC Tel:01412011219Address: QEUH

1345GovanRd GlasgowG514TF E-mail:[email protected]

OtherAuthors: ScottishSpecialistProstheticServiceBackground-SincetheintroductionoftheScottishSpecialistProstheticService(SSPS)in2014therehasbeentheopportunitytofitstateoftheartprostheticlimbstoalargenumberofamputeepatients.Theprostheticteamsbased in Glasgow and Edinburgh have had vast and varied experiences fitting most commercially availablemicroprocessorcontrolledknees.Microprocessor controlled knees (MPKs) have gained increasing popularity over the last decade with currentevidencesupportingtheirprovision.Researchhasshownspecificimprovementsinsafetyandenergyexpenditure.Objectives-Thispresentationwilldiscusstheimprovementsnotedinthetransfemoralamputeepopulationwhohavebeenfittedwithamicroprocessorcontrolledkneeaswellasthechallengesfaced.Casestudieswillbeusedtohighlightchangesingaitprofile,fallsandqualityoflife.Method -A rangeofbothpatient self-reportedandobjective clinicaloutcomemeasureswere collectedon56transfemoralpatientswhohavebeen fittedwithamicroprocessorcontrolledknee. Thisdatawascollectedatbaseline,3monthsand6months.Results - 6 patients abandoned use of the microprocessor controlled knee due to various reasons includingincreasedweight,poorcosmeticintegrationandlackofcommitmenttorehabilitation.Howeveroftheremainingsubjectsthemeanoutdoorwalkingdistancereportedbypatientsincreasedfrom1.27kmto2.12kmwithinthe6monthperiodfollowingprovisionofamicroprocessorcontrolledknee.2minutetimedwalkingtestand10mtimedwalkingtestresultshighlightthattransfemoralpatientswereabletowalkfurtherandatanincreasedspeedatthe6monthfollowup.Thepercentageofpatientshavingreportedfallsbeforebeingfittedwithamicroprocessorcontrolledkneereduceddramatically.Thiswashighlightedfurtherwithareportedincreaseinbalanceconfidenceusingaprosthesis.TheVicongaitanalysissystemhasshownimprovementinallkeygaitrelatedoutcomesmeasures:walkingvelocity,averagesteplength,steplengthsymmetry,weightdistributionandlowerlimbkinematicpatterns.Conclusion-Throughlocaldatacollectionincludingtheuseofoutcomemeasures,patientfeedbackandVicongaitanalysis an improvement has been noted in our transfemoral amputee population following the provision ofmicroprocessorcontrolledknees.Outcomeshaveshownthattheprovisionofamicroprocessorcontrolledkneecanimproveapatient’sfunctionalabilitywhilereducingtheriskoffalling.Furtherworkisrequiredhowevertodeterminewhichoutcomemeasuresaremosteffectiveatdetectingchange.There havebeen challenges regardingweight of themicroprocessor controlled knee, cosmetic integration andrehabilitation.

86

Title: Clinicalevaluationofameasurementsystemforloadingatthelowerlimbstump/socketinterface

Presenter: MichaelMcGrath,ResearchFellow,Dr

ContactAddress:

EngineeringandtheEnvironmentUniversityofSouthamptonHighfieldSouthamptonSO171BJ

Tel: (+44)2380592551

Fax: N/A


OtherAuthors:

JinghuaTang,PhDstudent,UniversityofSouthamptonNicholasHale,PhDstudent,UniversityofSouthampton

LiudiJiangPhD,Professor,UniversityofSouthampton

DanBaderPhD,Professor,UniversityofSouthamptonPiotrLaszczakPhD,ResearchEngineer,ChasA.Blatchford&SonsLtd.JianliangGaoPhD,ResearchFellow,UniversityofSouthampton

DavidMoserPhD,HeadofResearch,ChasA.Blatchford&SonsLtd.

SaeedZahediPhD,TechnicalDirector,ChasA.Blatchford&SonsLtd.

IntroductionTheeffectsofdynamicloadingatthelowerlimbstump/socketinterfacearewidelyagreedtoinfluencetheviabilityof the amputee’s stump tissues. Excess pressure can not only cause ulcers, but also reduce the threshold fortolerable shear, leading to further tissue damage. In order for clinicians to monitor these interfacial loadingconditions,areliablemeasurementsystemisrequired.UsingtheTri-axialPressureandShear(TRIPS)measurementsystem,recentlydescribedbytheauthors1,itsclinicalperformancewasassessedinthepresentstudy,byexaminingitsinter-testandinter-subjectvariability.MethodThree trans-tibial male amputees participated in thestudy. Wearing his preferred socket and prosthetic,each subject was asked to walk along a 10m levelwalkwayataself-selectedspeed.TRIPSsensorswereplacedatthepatellatendon(PT)andthesub-poplitealfossa (SPF). In addition, for one amputee, areproducibility study protocol was performed. Thisinvolvedthemeasurementofanumberofgaitcycles,afterwhichtheprostheticwasremoved,thenreplacedandthewalkingprotocolwasreplicated.Thisprocesswasrepeatedtoproduceatotalofthreedatasets.

ResultsBothpressureandshearvalueswereassessedagainstcomparable values previously published, whereavailable,withamaximumdifferenceof13% inpeakvalues2. The system revealed a high degree ofrepeatability across gait cycles for each amputee(Pearson’scorrelationcoefficient(PCC)=0.9,p<0.05),as well as reproducibility when the prosthetic wasdoffedandreplaced(PCC=0.8-0.9,p<0.05).Theinter-subjectcomparisonwasshowntoprovidereproducibleresultsforpressure(PCC=0.8-0.9,p<0.05),althoughawidervariation in shearmeasurementswasobtained(PCC=0.0-0.8,p<0.05).

Figure1:Reproducibilityofpressure(top)andshear(bottom)measurementsforsameamputeebetween

doffing/donning.Solidlinesshowmeans,shadedareasshow±onestandarddeviation.

87

DiscussionTheTRIPSinterfacemeasurementsystemwasshowntoperformwellinaclinicalenvironmentwithhighinter-testrepeatabilityforeachamputee.Theinter-subjectcomparisonshowedthatalthoughsimilarlevelsofpressuremaybemeasured,theshearmeasurementscouldbequitedifferent.Thesefindingsmightbeattributedtothelargevariationinstumpvolume,positionofbonyprominencesandqualityofsocketfitforthedifferentamputees.Anypotentialmonitoringsystemwouldneedatrainedprosthetisttoworkinconjunctionwiththeindividualamputeetodeterminetheiracceptablelevelsofloading.AcknowledgementsThisworkwassupportedbytheMRCandtheEPSRC,forwhichtheauthorsareextremelygrateful.References

1. LaszczakP,JiangL,BaderDL,MoserDandZahediS.Developmentandvalidationofa3D-printedinterfacialstresssensorforprostheticapplications.MedicalEngineering&Physics.2015;37:132-7.

2. SandersJE,LamD,DralleAJandOkumuraR.Interfacepressuresandshearstressesatthirteensocketsites

ontwopersonswithtranstibialamputation.JournalofRehabilitationResearchandDevelopment.1997;34:19-43.

88

Title: The3-layersiliconesocketdesignforlowerlimbamputees

Presenters: IanTalbot,SeniorProsthetist,SteeperGroup,AintreeUniversityHospital

LynzyHolding,SeniorProsthetist,SteeperGroup,AintreeUniversityHospital

Contactaddress: PAWC,AintreeUniversityHospital,LowerLane,Liverpool,L97AL

Tel:01515298758 Fax:01515298757 e-mail:[email protected]

Aims/objectives - Traditionalmaterials suchaspolypropylene, laminate,pelite,andblocked leatherhavebeenusedtomanufactureprostheticlowerlimbsocketsforthepastfewdecades.Morerecentdesignshaveseentheuseofatwo-partsocketwithasemiflexibleinnermanufacturedoutofNorthvaneorpolythene,andalaminateouternormallystuckinplacewithsomedoublesidedstickingtapeorrivets.

Recentadvancesinthe‘siliconebikinihip’manufacturedatAintreeprostheticandwheelchaircentrehaveoffereda new design concept which can be applied to lower limb prosthetic sockets. Giving the prosthetist moreopportunity to offer a comfortable silicone interface, specific pressure relief areas within the socket, andcomfortableflexiblebrimshapesallinaone-piecesocketdesign.

ThepresentationisaseriesofcasestudiesoflowerlimbamputeeswithdifferentlevelsofamputationwhoaccesstheAintreeprostheticandwheelchaircentre,eachcasestudyhasauniqueproblemorjustificationfortheuseofthesiliconesocketdesign.

Method-Afullassessmentwascarriedoutandthegoalsforthesocketdesignwereidentified.Eachpatientwascastaccordinglyfortheirlevelofamputationandthecastswererectifiedasclinicallyindicated.

Thesiliconesocketsweremanufacturedusinganew3-layertechniquedevelopedattheAintreeprostheticcentre.An internalcushioningsilicone interface layer.Acarbon frameforsupportandcomponentattachment,andanoutersiliconelayerforflexibilityattheproximalsocketmargins.

Results - Socket comfort scoreswereobtained retrospectively for pre andpost definitive silicone sockets. Theobjectivesofthesocketdesignwererecordedandscoredagainst.Timedupandgo,3-minuteand6-minutewalktestswerecarriedoutonsuitablepatients.

Results show an improvement in socket comfort scores, objectives were met by the new sockets, andimprovementswereobservedinthegetup&go&timedwalktests.

Conclusion-Theinitialevidenceobservedinthesecasestudiesindicatethatthesilicone3-layersocketdesigncanbeausefuloptionwhendesigningsocketsforlowerlimbamputees.Theycanbespecificallydesignedtohelptheamputee achieve a variety goals including pressure relief, proximal brim comfort, improved suspension, &waterproof/swimminggoals.

89

Title: Towardsacomputationallyefficientmodeloftranstibialsocketfitting

Presenter: JWSteer,PhDStudent,Mr

Address: 7/4055,FacultyofEngineeringandtheEnvironmentUniversityofSouthampton,UniversityRoad,Southampton,SO171BJ

Tel:02380597665


OtherAuthors: DrASDickinson,Lecturer,UniversityofSouthampton

Aims:Thedesignofatranstibialamputee’ssocketisstillalargelyskill-basedprocess,withlittleinformationavailabletotheprosthetistspasttheirownjudgementandexperience1.Finiteelementbasedcomputationalmodelsareusedto predict the stresses and strains within structures, and have had considerable success within other areasbioengineering,suchasstructuralanalysisandpre-operativeplanningoftotaljointreplacements.Computationalmodelshavelongbeenidentifiedasapossibletechniquetoassisttheprosthetistinsocketfitting.Severalacademicstudieshavedemonstratedtheirpotential2,howeveritisstillnotusedwithinaclinicalsetting.Thisstudyaimstodemonstrateaninitial,computational-basedmethodologyfortrailingdifferentsocketdesignsonapatient.Methods:Theresiduumexternalgeometrywasgeneratedfromdigitalscanningofanunrectifiedcastofatranstibialamputee.Statisticalshapemodelswereusedtocreatetheskeletalstructuresofthepatientandtheligamentousstructureswere modelled manually. Three simplified Total Surface Bearing sockets were generated with distal volumereductionsof2.0%,3.5%and5.0%,respectively.Atwostageloadingprocedureofthesocketontotheresiduumwasperformed.Thesocketwasdonnedfromapositionofnocontactandthenloadedtosimulatesingle-legstance.Thefiniteelementmodelwasusedtopredictsofttissuestrainsandskin-socketcontactpressureforeachofthesocketdesigns.ResultsandDiscussion:Simulation of the donning procedure enabled prediction of pre-stresses from the interference fit between thesocketandresiduum.Whenthesocketwasloaded,peakskincontactpressurewaspredictedtoreducewiththereductioninsocketvolume(120kPafor2.0%,99kPafor3.5%and67kPafor5.0%rectifications).Thiseffectwasmost apparent at the tip of the residuum in keeping with socket fitting theory. Peak soft tissue strains werepredictedintheregionofthepatellatendonandaroundthedistalendofthetibiaforallsockets.

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Thisstudy’smainlimitationisthattheinitialmodelisgeneralised.Thegeometrywasdigitallygeneratedinorderto represent a typical, but non-patient-specific case, and material properties and load cases were taken fromliteraturesources. However,thepresentedmethodswouldbeapplicabletogeneratingpatient-specificmodelsfromimagingandbiomechanicalanalysisdata.Conclusions:This study has demonstrated a methodology for using computational techniques to trial different socketrectificationsonatranstibialamputee.Whileexperimentalvalidationhasnotyetbeenconducted,thereductioninskincontactpressurewithareductioninsocketvolumewascorroboratedbysocketfittingtheory.Futurestudieswill focusuponapplyingsimilarmethodstorealpatientsandcollectingexperimentaldataformodelvalidation.Additionally, dynamic loading and different socket rectification techniques will be considered. Through futurestudies,theaimistodevelopaclinicallytranslatablecomputationalmodel.References:

1. Pezzin L,DillinghamT,MacKenzieE, EphraimP,RossbachP.UseandSatisfactionWithProsthetic LimbDevicesandRelatedServices.ArchPhysMedRehabil2004;85:723-729

2. SengehS,MoermanK,PetronA,HerrH.Multi-Material3-DViscoelasticModelofaTranstibialResiduumfromIn-vivoIndentationandMRIData.J.Mech.Behav.Biomed.Mater2016;59:218-228

91

Title: Assessmentofsocketinterfacekinematicsandkineticsbasedonatrans-femoralamputeecasestudy

Presenter: JinghuaTang,PhDStudent,Mr

Address: FacultyofEngineeringandtheEnvironmentUniversityofSouthamptonHighfieldSouthamptonSO171BJ

Tel:02380592899E-mail:[email protected]

OtherAuthors:

MichaelMcGrathPhD,ResearchFellow,UniversityofSouthamptonNickHalePhDStudent,UniversityofSouthamptonLiudiJiangPhD,Professor,UniversityofSouthamptonDanBaderPhD,Professor,UniversityofSouthamptonDavidMoserPhD,HeadofResearch,BlatchfordSaeedZahediProfessor,TechnicalDirector,BlatchfordPiotrLaszczakPhD,ResearchEngineer,BlatchfordJoeMcCarthy,PrincipleProsthetist,BlatchfordRichardBradbury,ResearchProstheticTechnician,Blatchford

Introduction-Functionalprosthesis,suchasmicroprocessor-controlledankle,hasbeendevelopedtooptimisethewalkingstabilityondifferentterrains.Understandingthemechanicalcouplingattheresiduum/socketinterfaceinrelationtoadaptationsattheprostheticanklecouldpotentiallyaidtheoptimizationoftheprostheticcomponents.Thisapproachexploitsapreviouslyreportednovel3Dmotioncapturemethod1andatri-axialpressureandshear(TRIPS) interface sensor system2 to provide real time kinematic and kinetic information, respectively, duringambulationofaknee-disarticulationamputee.

Method-Thecasestudyinvolvedaknee-disarticulationamputeefittedwithanElanTMfoot,KX06kneeandsupra-condylarsuspensionsocket.3TRIPSsensorswere locatedattheanterior-proximal(AP),posterior-proximal(PP)andanterior-distal(AD)regionsoftheresiduum.Thesubjectwasthenaskedtowalkonbothalevelsurfaceanda5° descending and ascending surfaces, respectively. The socket interface coupling kinematicswas assessedbyanalysingangularandaxialcouplingsattheinterfacebasedonoutputsfromaCODA3Dmotioncapturesystem.Amputeewalkingtestswerealsoconductedafteradaptingdifferentankleplantar/dorsi-flexionresistancesettingsoftheprostheticfootduringrampdescent.SignaloutputsfromthegaitlabandTRIPSsensorsweresynchronizedduringeachtest.

Results&Discussion-Duringlevelwalking,thekinematicsshowsupto9°angularcouplinginthesagittalplaneandupto30mmaxialcouplingattheinterface.DoublepeakpressureprofileswereobtainedfromtheTRIPSsensorsatPP,APandADregionsoftheresiduumwithpeakvaluesofapproximately56kPa,31kPaand67kPa,respectively.HigherPPthanAPpeakpressuressuggestsresiduumengagementatthePPregionofthesocket,alignswiththeobservedkinematicprofile.ThelongitudinalshearstressesatthePP,APandADregionsattainedvaluesof36kPa,2kPaand5kPa,respectively.Theprofileoftheresultantstressesatthreelocationsmatcheswellwiththechangeinaxialcoupling.

Duringrampdescent,forbothPPandAPregions,pressureincreasesofupto20%,wereobservedinearlystancephasecomparedtovalues intheterminalstancephase.Furthermore, theresiduumwasexposedtoupto20%moreangularmovementinearlystancephasethanthatinterminalstance.Thisfindingmightbeattributedtothe

92

greaterbrakingforceneededforlimbsafetyandstability.Indeed,whenbrakingmodewasactivatedontheElanTMfoot,upto14%additionalbrakingimpulsewasachieved.Thisledtoa17%reductionatADregionoftheresiduum.Nosignificantchangeswerefoundwiththeshearstresses.

Bycontrast,duringrampascentforbothPPandAPregions,higherpressure(upto16%)wereobservedinterminalstancephasecomparedwithearlystancephase.WithassistmodeactivatedontheElanTMfootduringrampascent,anincreaseofapproximately6%ofpropulsionimpulsewasevident.Thisalsoresultsinareductionofapproximately40%forpressureandupto35%forcircumferentialshearstressesonADregionoftheresiduum.Nosignificantchangeswerefoundwiththelongitudinalshearstresses.

Conclusion-Inthisstudy,techniquesofassessingsocketinterfacebiomechanicsweredemonstratedinrelationtodifferentterrains.Theapproachcouldpotentiallybeusedtoaccesseffectofdifferentclinicalinterventionsontheresiduum/socket interfacebiomechanics.Furtherwork is requiredtoquantify theseseffects in largergroupsofamputees.

Acknowledgements-ThisworkwassupportedbytheMRCandtheEPSRCforwhichtheauthorsareextremelygrateful.

References1. TangJ,McGrathM,LaszczakP,etal.Characterisationofdynamiccouplingsatlowerlimbresiduum/socketinterfaceusing3Dmotioncapture.MedEngPhys.2015;37:1162-8.2. LaszczakP,McGrathM,TangJ,etal.Apressureandshearsensorsystemforstressmeasurementatlowerlimbresiduum/socketinterface.MedEngPhys.2016;38:695-700.

93

TheBlatchfordLecture

Title: TargetedMuscleReinnervation

Presenter: LeviJHargrove,AssociateProfessor,DepartmentsofPhysicalMedicine&RehabilitationandMcCormickSchoolofEngineering,NorthwesternUniversity,Chicago,IL,USAandDirector,NeuralEngineeringforProstheticsandOrthoticsLaboratory,RehabilitationInstituteofChicago,IL,USA


Amputationisamajorcauseofdisabilityacrosstheglobeandistreatedmosteffectivelywithaprostheticlimb.Recentadvancesinroboticshaveallowedforthecreationofstrong,lightweightandenergy-efficientprosthetics.We,attheCenterforBionicMedicine,partoftheRehabilitationInstituteofChicago,havedevelopedatechniquecalledtargetedmusclereinnervation,whichrestoresmyoelectricsignalsofamputeepatientsandprovidesarichsourceofneuralinformationthatcanbeusedtocontrolprostheticlimbs.Originallydevelopedforcontrollingupper-limbprostheses,wehavenowbeenworkingtoextendthisneuralinterfaceforpoweredlegs,anemergingclassofprostheticlimbsthatarenowreachingthemarket.

This presentationwill brieflyprovideanoverviewofour targetedmuscle reinnervationwork as it relates tocontrollingupperandlowerlimbprostheses.Itwillalsodescribeclinicalapplicationofnewcontrolalgorithms,and provide quantitative data supporting the use of EMG signals to improve ambulation with powered legprostheses.

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ABSTRACTS-Saturday1October–OrthoticsStream(inorderofpresentation)

TheOETTLecture

Title: OrthoticsinaDigitalWorld

Presenter: ChrisDrake,DipOTC,BAPO,CUEW,MEWI,ConsultantOrthotistOrthoticExpertsLtd,Surrey,UK


AlargenumberofpeoplearenowdigitallyconnectedallovertheworldanditwasreportedbyTheIndependentin2014thattherearenowmoremobiledevicesontheplanetthanpeople.

Now that digital technology has become fused into our daily lives, how is it currently being used in clinicalorthoticstoday?

Asdigitaltechnologiesevolveandbecomemorewidelyusedinhealthcarepathways,orthosesproductionanddelivery,whatarethepossibleconsequencesfortheOrthoticindustry?

Thispresentationintendstoprovideanoverviewofcurrenttrendsandtoopenandstimulatediscussionwiththeaudienceabouthowtheyseetheuseofdigitaltechnologyinthefuture.Shouldweembraceorfearwhatliesaheadintheevergrowingdigitalworld?

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Title: Effectivenessandcosteffectivenessofprostheticsandorthoticsservices/interventionsPresenter: AHealy,SeniorResearchOfficer,Dr.Contact ScienceCentre(R009) Tel:01782292797Address: StaffordshireUniversity Fax:01782294321

LeekRd E-mail:[email protected]

Other SFarmer,Physiotherapist/Researcher,StaffordshireUniversity,StokeOnTrentAuthors: APandyan,ProfessorofRehabilitationTechnology,KeeleUniversity,Keele/

StaffordshireUniversity,StokeOnTrent NEddison,PrincipalOrthotist,RoyalWolverhamptonNHSTrust,Wolverhampton JAllcock,ResearchAssistant,StaffordshireUniversity,StokeOnTrent TPerry,ResearchAssistant,StaffordshireUniversity,StokeOnTrent NChockalingam,ProfessorofClinicalBiomechanics,StaffordshireUniversity, StokeOnTrent

Aim: The aim of this systematic review was to establish what is known from the existing literature about theeffectivenessandcosteffectivenessofprostheticsandorthoticsservices/interventions.Methods:Thissystematicreviewsearched14databases(WebofScience,Medline,PubMed,CINAHLPlus,EMBASE,SCOPUS,Rehabdata,PsycInfo,ERIC,EducationResearchComplete,BusinessSourceComplete,IEEE,NIHRandCEARegistry)usingMeSHheadingsandfreetexttermsfororthoticsandprostheticstocaptureallresearchintheareaoforthoticsandprosthetics(restrictedtothelast20years;1995–2015).Metadataincludingthecorrespondingauthor’scountryaffiliation,yearofpublication,andpublicationlanguagewereextractedfromthesearchresults.Data(studyparticipants,prosthetic/orthotic intervention(s),outcomemeasure)relatingtothecharacteristicsoftheincludedrandomisedcontrolledtrials(RCTs)wereextracted.Results:Atotalof28,958articleswereidentifiedfromthedatabasesearches.Thistotalwasreducedto2,639byconcentrating on RCTs and those studies which examined cost-effectiveness. Research in this area havepredominantlybeenconductedinasmallnumberofcountries(Australia,Canada,Germany,Netherlands,UKandUSA). 321 randomised controlled trials examining the effectiveness/cost-effectiveness of orthoticsservices/interventionswereidentifiedandonly4RCTsexaminingprostheticswereidentified.Themajorityofthisresearchexaminedtheadultpopulationandlowerlimborthotics.Conclusions:Resultsofthissystematicreviewdemonstratethegrowthofresearchintheareaofprostheticsandorthoticsoverthelast20years.ThemajorityofresearchinthisareahasfocusedonorthoticswithscareRCTsonlower limb prosthetics and none on upper limb prosthetics. A large variety of outcomes measures examiningaspectsoffunction,activityandparticipationareusedinthesestudieswhichcomplicatesthesynthesisofdatatoformconclusionsoneffectiveness/costeffectivenessofprostheticsandorthoticsservices/interventions.Fundingsource:ThisworkwassupportedbytheInternationalSocietyforProstheticsandOrthotics(ISPO)(Sub-grantfromISPO’sCollaborativeAgreementwithUSAIDRehabilitationofphysicallydisabledpeopleindevelopingcountries–USAIDcooperativeagreementDFD-A-00-08-00309-00.).

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Title: UseoftheTheoryofPlannedBehaviourtounderstandbeliefsaboutuseofAnkle-FootOrthoses(AFOs)inpeoplewithstroke

Presenter: ChristineMcMonagle,TeachingFellowContact: NCPO,DepartmentofBiomedicalEngineering, UniversityofStrathclyde,131StJamesRoad, Glasgow,G40LS

Tel: 01415483525E-Mail: [email protected] Dr.SusanRasmussen,Dr.MarkElliott,SchoolofPsychologicalSciencesandHealth,Authors: UniversityofStrathclyde;MrRobbieRooney,OrthoticsLead,NHSLanarkshire Introduction:Ankle-footOrthoses(AFOs)areprescribedtopeopleafterstroketoimprovemobility.HoweverlittleisknownaboutuseofAFOsafterdeliveryandreasonsfornon-adherencefollowingstroke.ManypeoplewhohavebeenprescribedAFOsmayusethemdifferentlytorecommended,ormaynotevenknowrecommendationsforuse.UseofAFOscanbeconsideredahealthbehaviour.Consequently,psychologicaltheoriesofbehaviourcanbeusedtounderstandAFOuse.

AimofStudy:TheaimofthisstudywastoidentifybeliefsaffectinguseofAFOsinpeoplewithstroke,usingtheTheoryofPlannedBehaviour(TPB)1asaguidingframework.

Method:Participantswere13peoplelivingwithstrokewhohadbeenprescribedanAFObyNHSLanarkshire.A10+3modelwasused2.Tenparticipantswereinterviewedinitially,withnonewthemesemergingforanadditional3participants.Thereforedatasaturationwasachieved.ParticipantswereinterviewedtoelicitbeliefsaboutusingAFOs,usingastructuredquestionnaire.Contentanalysiswasusedtogrouptheresponsesintothemes.Results:Participantswere6malesand7femaleswithameanageof67.2yrs.FourparticipantsreportedusingtheAFOasrecommended,twoparticipantsdidnotuseatall;6usedlessthanrecommendedandonereportedusingmorethanrecommended.ThisgroupisconsideredareasonablyrepresentativegroupofallpeoplewithstrokewhohavebeenprescribedAFOsinLanarkshire.Arangeofbeliefswereelicited,bothpositiveandnegative in linewiththeTPB.PositiveandnegativeattitudestowardsusingtheAFOincluded:‘supportsthepositionofthefoot’and‘poorstyleoffootwear’.Normativebeliefswereinfluencedby3maingroups:family,friendsandhealthprofessionals.Participantsreportedfactorsthatmadethe AFO easier to use such as ‘being motivated’ and factors that made the AFO more difficult to use such as‘challengesinputtingtheAFOon/off’.Discussion&Conclusion:TheTPBprovidedausefulframeworktoinvestigatebeliefsrelatingtoAFOuseinpeoplewith stroke. A range of beliefs were elicited, relating to attitudes, subjective norms and perceived behaviouralcontrol.AfewparticipantsrelatedtheirdisappointmentwhentheyrealisedtheyrequiredtouseanAFOinthelonger term. This suggests the importance of managing user expectations when first prescribing an AFO. Anunderstanding of beliefs of people with stroke about using orthoses may help allied health professionals tocomprehendreasonsfornon-adherence.ThisstudyusedtheTPBtoidentifybeliefsaboutAFOuseinpeoplewithstroke.ThebeliefselicitedwillbeusedinaquestionnairetotesttheefficacyoftheTPBinpredictingAFOuse.ThisknowledgemayallowdevelopmentoftheorybasedinterventionstoincreasemobilitybyuseofAFOs.References

1. AjzenI.Thetheoryofplannedbehaviour.OrganisationalBehaviourandDecisionprocesses.1991;50:179-211.2. FrancisJJ,JohnstonM,RobertsonC,etal.Whatisanadequatesamplesize?Operationalisingdatasaturationfortheory-basedinterviewstudies.Psychology&health.2010;25:1229-45.

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Title: ExtendingPractice:TheRoleofanOrthotistwithintheOrthopaedicClinic

Presenter: LauraBarr,ExtendedScopeOrthotist(Foot&AnkleOrthopaedics), GreaterGlasgow&ClydeNHS,Glasgow,UK


RoleextensionintheHNSisanincreasinglypopularmeansofimprovingpatientcareandwaittimes,byutilisingtheskillsofhighlytrainednon-medicalpractitionerswithintraditionallymedicalsettings.

This presentation will provide an overview of the clinical responsibilities and case load of an Extended ScopeOrthotistwithinanOrthopaedicFootandAnkleclinic.

Theadditionaltrainingundertakenaspartofthisrolewillbediscussed,aswellasconsiderationtothetransferablenatureofsuchskillsincomplimentinggeneralorthoticpractice.

Title: Lowerlimbsalvage:“adoubleedgesword”

Presenter: FrankLBowling,MSc(Surg)DPM,PhD,FFPM,RCPSPodiatricDoctor(Surgery),UniversityofManchester,Manchester,UK


Long standing lesions under the metatarsal heads commonly lead to infection of the bone or soft tissue,amputationaretheeventualsequelaebetween14%to28%ofpatientswithdiabetes.Long-termrehabilitationisrarelysuccessfulinpatientswhoreceiveamajoramputation(aboveorbelowknee),only5%ofthesepatientscanuseaprosthesistoambulateandmostpatientsremainwheelchair-boundafterfiveyears.

Forneuropathicpatientswithtransferlesionsafterapartial/completerayormetatarsalheadresection,salvageproceduresthatprovideaplantigradeplatformofthefootstumpmayofferagreaterpossibility for long-termfunction.

Title: TheuseofCAD/CAMTechnologyinclinic

Presenter: FrancescaMakey,Orthotist&NigelBirkett,ProductionManager,PlasticsChasABlatchford&SonsLtd,11AtlasWay,Sheffield,S47QQ

E-mail: [email protected]@blatchford.co.uk

ThispresentationwillprovideageneralupdateonhowCAD/CAMtechnologycanbeusedtodevelopnewproducts.Thebenefitsofusingscannersinclinicatthemanufacturingfacilitywillbediscussedalongwithinformationontypeofscanners,softwareandcarverscurrentlyused.ThistechnologyhasbeenusedinpartnershipwithaGermanscoliosisspecialist,DrHans-RudolfWeissinordertoprovidetheGensingenspinalbraceinourSheffieldfacility.Theresultsareinspiring!

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Acknowledgements

TimBachforconferencetimetablingsoftware

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PeterKyberd IreneCameron

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Documents

The Compendium - ISPO UK MS · By way of background, t he Trent Prosthetics Symposium (TPS) was the vision of three clinicians from the Nottingham area: Vivian Ibbotson, Janet Kingston