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Introduction: To support clinicians who treat children with upper-limb differences, we must first understand how these children are treated around the world. Study Design: A descriptive survey was carried out in this study. Objectives: The aim was to describe how treatment for children with upper-limb difference is provided in different parts of the world. Methods: A web-based survey was used to gather data. The survey was shared on the Handsmart website, through providers and members using snowball sampling. Results: Sixty-eight respondents from 18 countries, with most being occupational therapists and prosthetists, participated. All respondents reported that they provide prosthetic treatment and most fit a passive prosthesis before 1 year of age. Respondents from 13 countries reported having governmental funding for the provision of care for people with upper-limb loss. Intervention is guided by the presentation of the limb as well as availability of funding and other resources. In 12 countries, no treatment other than fitting of prostheses is provided for the children. The children who do not receive a prosthesis continue to see an occupational or physical therapist for other treatment (other devices, follow-up). Respondents stated that they would like to see clear treatment guidelines used by multidisciplinary teams to fit children and that treatment should include regular follow-up. Conclusions: Children are treated differently in various parts of the world based on different funding, family support, and therapy resources. Further studies should encompass a geographically representative sample of children's clinics. Clinical Relevance: This study provides information regarding treatment practices for children with upper-limb loss/difference in various parts of the world; prosthetic treatment is common for children, although ages for fitting vary among clinics and countries. Results will contribute by supporting clinicians to provide better treatment for children with upper-limb loss/difference. [ABSTRACT FROM AUTHOR]

To guide better prevention and treatment and to develop research priorities, this study aims to create an overview of facilitators and barriers for the development and persistence of musculoskeletal complaints (MSCs) in individuals with upper limb absence (ULA). Exploratory mixed methods design. A focus group (FG) was organized with individuals with ULA about MSCs and associated factors. An inductive approach was employed to the transcript and the studies. A scoping review was performed to systematically identify barriers and facilitators. The International Classification of Functioning, Disability, and Health was used to create an integrated overview of the results. Eleven participants participated in the FG, eight of them currently sustained or had sustained MSCs in the last year. Ten studies were included in the scoping review. The final overview consisted of 67 associated factors. Participants of the FG predominantly mentioned psychosocial factors, whereas the literature dominantly reported biomechanical factors. The extensive overview of 67 factors showed that facilitators and barriers for MSCs are heterogeneous and aids in a better understanding of the complex nature of MSCs. Several biomechanical and psychosocial factors contribute to MSCs, but the association with a prosthesis remains unclear. Musculoskeletal complaints (MSCs) are highly prevalent in the population with upper limb absence (ULA) and the overview of 67 factors could help in the prevention and treatment of MSCs. Psychosocial factors in the development and persistence of MSCs are underreported in literature, but are important contributors to MSCs according to patients. Wearing a prosthesis does not seem to be protective for the development or persistence of MSCs. Social support, especially from significant others and employers, is essential to help protect MSCs in those with ULA. [ABSTRACT FROM AUTHOR]

Introduction: Understanding repair patterns of upper-limb (UL) prosthetic devices have received little attention compared with their lower-limb counterparts. This study focuses on a retrospective analysis of anonymized UL prosthetic maintenance data to establish if there were any patterns of repairs at a regional prosthetic limb-fitting center in the United Kingdom. A secondary aim of this study is to describe the patient demographics of this center. Methods: Data containing prosthetic repair log and demographic description (n = 212) were acquired through our clinical partners and subjected to statistical analyses. Results: On average, each client visited the center 0.2 times/year for a new device and 0.9 times/year for maintenance-related activities. It is found that the repair rates are generally higher for body-powered devices (1.28 visits/device per year) compared with passive (0.94 visits/device per year) and externally powered devices (0.90 visits/device per year). In keeping with the typical UK UL-deficient population, there is a high male-to-female ratio, and higher instances of traumatic amputations were noticed for males at the center. There is a very high preponderance of congenital cases and an overall emphasis on prescribing passive devices to a majority of patients at the center. Conclusions: The data from our study are similar to previously published data from other centers and show a consistent pattern in terms of relative rates of maintenance attendances for different types of UL prostheses. Clinical Relevance: This study provides a longitudinal perspective and insights on ever-changing requirements (prostheses and related care) of the users at the level of a regional limb-fitting center. This study underscores current gaps in prosthetic device durability/reliability and opens up avenues for improvement of prosthetic services and devices. [ABSTRACT FROM AUTHOR]

Purpose: Rehabilitative care for children with limb difference often includes the provision and use of an artificial (or prosthetic) limb. Of key influence in this process is how parents experience and respond to their child's limb difference and prosthesis use. However, research on this is lacking. Therefore, this study aimed to explore the experiences of parenting a child with limb difference who had been provided with an artificial limb. Design: Semi-structured interviews took place with seven parents. Interview data was recorded, transcribed and analyzed using interpretative phenomenological analysis. Results: The analysis identified four themes: (1) managing the initial emotional experience through the development of coping resources; (2) opportunities through prosthesis use and its relationship with "normality"; (3) managing and making sense of social reactions toward their child; (4) the intrinsic role of support: developing a collective connection and enabling shared knowledge. Conclusions: The study highlighted salient aspects to parents' experiences and sense-making that can inform clinical support. Emotional support, the management of social responses, and the holistic co-ordination of healthcare support with peer support networks are discussed. Healthcare professionals involved in the prosthetic rehabilitation process should look to explore these meanings to help support the management of the child's prosthesis use. Understanding the sense-making of parents is important in effective service provision for children with limb difference. Service provision for children with limb difference should consider the support needs of parents. Working with limb difference charities and voluntary organizations could help services develop needed parent-to-parent support networks. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Introduction: This article presents a unique case study of an individual with congenital limb loss and long-time (>56 years) body-powered prosthesis use, who was able to control a sophisticated robotic upper-limb prosthesis using surface electromyography signals and pattern recognition (PR) algorithms. This case demonstrates that individuals with congenital limb amputation are able to learn unique strategies to intuitively control a dexterous prosthetic limb. Materials and Methods: After completing four training sessions using a virtual integration environment, a single subject participated in 12 in-laboratory clinical training sessions using the modular prosthetic limb (MPL)—a novel multiple–degree-of-freedom dexterous upper-limb prosthesis prototype. Baseline assessments were made with her body-powered prosthesis, as well as a two-site direct-control myoelectric Bebionic she had recently received. Functional assessments with the MPL were conducted during sessions 6 and 12. Outcome measures included timed box and blocks (BB) test, Assessment of Capacity for Myoelectric Control (ACMC), Jebsen-Taylor Hand Function Test (JTHFT), Trinity Amputation and Prosthesis Experience Scale, Upper Extremity Functional Scale (UEFS), and NASA Task Load Index. Results: The subject was able to control two independent wrist degrees of freedom and up to three independent hand grasps of the MPL, using an array of surface electrodes. Improvements in the BB and ACMC were observed, although the total time to complete the JTHFT stayed relatively the same from weeks 6 to 12, using the MPL. While her enpoint perceived funcitonal ability with the MPL was 58% compared with 83% with her personal myoelectric prosthesis (12 hours of use vs 4–5 weeks of use as denoted on the UEFS); the subject reported short length of training, a long-term body-powered prosthetic user with congenital limb loss was able to demonstrate objective improvements in control of a dexterous prosthetic hand over a 12-week period of in-laboratory training, achieving intuitive independent control of a variety of simultaneous individual wrist motions and grasp patterns using PR. Conclusions: This case demonstrates that even individuals with congenital amputation may be considered as candidates for upper-limb PR-controlled myoelectric prosthetic devices using surface electrodes. [ABSTRACT FROM AUTHOR]

Introduction: There is limited knowledge on the use of 3 D-printed transitional prostheses, as they relate to changes in function and strength. Therefore, the purpose of this study was to identify functional and strength changes after usage of 3 D-printed transitional prostheses for multiple weeks for children with upper-limb differences. Materials and methods: Gross manual dexterity was assessed using the Box and Block Test and wrist strength was measured using a dynamometer. This testing was conducted before and after a period of 24 ± 2.61 weeks of using a 3 D-printed transitional prosthesis. The 11 children (five girls and six boys; 3-15 years of age) who participated in the study, were fitted with a 3 D-printed transitional partial hand (n = 9) or an arm (n = 2) prosthesis. Results: Separate two-way repeated measures ANOVAs were performed to analyze function and strength data. There was a significant hand by time interaction for function, but not for strength. Conclusion and relevance to the study of disability and rehabilitation: The increase in manual gross dexterity suggests that the Cyborg Beast 2 3 D-printed prosthesis can be used as a transitional device to improve function in children with traumatic or congenital upper-limb differences. Implications for Rehabilitation: Children's prosthetic needs are complex due to their small size, rapid growth, and psychosocial development. Advancements in computer-aided design and additive manufacturing offer the possibility of designing and printing transitional prostheses at a very low cost, but there is limited knowledge on the function of this type of devices. The use of 3D printed transitional prostheses may improve manual gross dexterity in children after several weeks of using it. [ABSTRACT FROM AUTHOR]

There are a number of considerations that clinicians weigh when guiding patients through the decision-making processes associated with upper-limb prosthetic rehabilitation. While clinical guidance is essential to such decisions, especially for an individual's first prosthesis, many patients benefit from peer mentoring and interaction. The opportunity to speak to someone who has experienced what they are going through can be extremely valuable and appreciated. Thoughtful clinicians have also benefited from years of listening to the perspectives of their patient clientele. The intent of this article is to present two users' perspectives that canvass some of the various considerations associated with congenital deficiency versus acquired limb amputation, unilateral versus bilateral limb absence, and the perceived benefits associated with body-powered and externally powered systems. [ABSTRACT FROM AUTHOR]

There are a number of considerations that clinicians weigh when guiding patients through the decision-making processes associated with upper-limb prosthetic rehabilitation. While clinical guidance is essential to such decisions, especially for an individual's first prosthesis, many patients benefit from peer mentoring and interaction. The opportunity to speak to someone who has experienced what they are going through can be extremely valuable and appreciated. Thoughtful clinicians have also benefited from years of listening to the perspectives of their patient clientele. The intent of this article is to present two users' perspectives that canvass some of the various considerations associated with congenital deficiency versus acquired limb amputation, unilateral versus bilateral limb absence, and the perceived benefits associated with body-powered and externally powered systems. [ABSTRACT FROM AUTHOR]

Introduction: During transition to adulthood young adults with disabilities are at risk of experiencing limitations due to changing physical and social requirements. Purpose: To determine whether young adults with transversal upper limb reduction deficiency (tULRD) have experienced limitations in various domains of participation during transition to adulthood and how they dealt with these limitations. Participants: Fifteen participants (mean age 21.4 years) with tULRD. Methods: A qualitative study was performed using a semi-structured interview based on the Rotterdam Transition Profile to identify the limitations experienced in participation domains. Results: Almost all the participants reported difficulties in finding a suitable study or job. Most young adults were convinced they were suitable for almost any study or job, but their teachers and potential employers were more reserved. Few difficulties were reported on the domains leisure activities, intimate relationships/sexuality, housing/housekeeping and transportation. Participants preferred to develop their own strategies for dealing with limitations. Various aids, adaptations and prostheses were used to overcome limitations. Rehabilitation teams were infrequently consulted for advice in solving transitional problems. Conclusion: Young adults with tULRD experience limitations mainly in choosing and finding a suitable study or job. Rehabilitation teams may play a more extensive role in supporting individuals with transitional problems. [ABSTRACT FROM AUTHOR]

Aim: To study psychosocial adjustment and mental health in children with upper-limb reduction deficiency and a myoelectric prosthetic hand.Methods: Sixty-two parents of children aged 8 to 18 y old answered a questionnaire concerning competence and behaviour/emotional problems in their children. Of the 62 children, 37 adolescents aged 11 to 18 y old answered questionnaires concerning competence, problems and mood state. The results were compared with Swedish normative data. The children were divided into five groups based on degree of myoelectric prosthetic use.Results: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand showed social competence and behaviour/emotional problems similar to Swedish standardized norms. However, withdrawn behaviour was significantly higher in all children, social competence was significantly lower in girls, and social activities were significantly lower in older children with upper-limb reduction deficiency. There was a significant difference between prosthetic use groups. Non-users had significantly more delinquent behaviour problems than full-time users. There was an interaction between gender and prosthetic use in their affect on competence and behaviour/emotional problems, yielding two contrasting patterns.Conclusion: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand are as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency, which have to be considered differently in boys and girls. [ABSTRACT FROM AUTHOR]

INTRODUCTION Myoelectric prostheses can provide improved control for upperextremity amputees compared with body-powered devices. However, newer technologies rely on learned muscle contraction (e.g., “open your hand,” “supinate your wrist”) to control the prosthesis. Difficulty with control is a contributing factor to rejection rates and frustration with myoelectric upper-limb prostheses (Wurth, 2014). Pattern recognition (PR) control has been shown to improve control accuracy and proficiency with myoelectric prostheses for patients with traumatic upper-limb loss (Deeny, 2014; Hargrove 2010). It is currently not known if patients with congenital upper;extremity limb difference (amputations)—who have never learned to use their distal upper extremity—can generate the myoelectric signal patterns necessary to control a multi-degree of freedom (DOF) device. Here, we evaluate the ability of congenital upper-extremity amputees to control a multi-DOF prosthesis using myoelectric patterns. METHOD Subjects: Patients ≥8 years of age with unilateral, congenital transradial limb difference were included in an IRB-approved protocol. Patients with any inability to comply with the testing protocol (cognitive or visual impairment, non-English speaking, or age <8 years) were excluded. Apparatus: A handheld electromyography unit with graphical user interface displayed on a laptop recorded myoelectric signals to calibrate a pattern-recognition control strategy (COAPT Handheld Demo Unit, COAPT Engineering, Chicago, IL). Procedures: The complexity of control was increased incrementally from one to three DOF. The accuracy of the pattern-recognition calibration and performance on a virtual Target Achievement Control (TAC) test were recorded. The sound limb was tested first to control for ability to complete the testing protocol and to generate a paired sample data set with the congenital residual limb performance. Data Analysis: Mean calibration accuracy and completion rate on the TAC test were calculated for sound limb and congenital limb difference. RESULTS Three patients have completed the study protocol to date. The average calibration accuracy for the pattern recognition control was 99.0%, 99.0%, and 95.3% for the sound limb and 99.3%, 96.0%, and 93.7% for the congenital residual limb using a one-DOF, two- DOF, and three-DOF virtual prosthesis, respectively. The average completion rate on the TAC test was 100%, 88.9%, and 58.3% for the sound limb and 66.7%, 88.9%, and 83.3% for the congenital residual limb using a one-DOF, two-DOF, and three-DOF virtual prosthesis, respectively. DISCUSSION Calibration accuracy was comparable across configurations and control complexity (DOF). TAC completion rate demonstrated improved performance with the sound limb at one DOF, but improved performance at three DOF with the congenital residual limb. Ordering effect and training effect may have impacted the higher completion rates with the final testing configuration, as the sound limb was tested before the congenital residual limb, and the complexity was increased incrementally from one to three. CONCLUSION Patients with congenital upper-extremity differences achieved pattern-recognition control calibration of multi-DOF, as expected. Completion rates were higher for the congenital residual limb than the sound limb at higher levels of control complexity. This demonstrates the potential for patients born with congenital limb differences to benefit from pattern-recognition controlled myoelectric prostheses. [ABSTRACT FROM AUTHOR]

Background: Co-contraction is the simultaneous activation of agonist and antagonist muscles that produces forces around a joint. It is unknown if the use of a wrist-driven 3D printed transitional prostheses has any influence on the neuromuscular motor control strategies of the affected hand of children with unilateral upper-limb reduction deficiencies. Thus, the purpose of the current investigation was to examine the coactivation index (CI) of children with congenital upper-limb reduction deficiencies before and after 6 months of using a wrist-driven 3D printed partial hand prosthesis.Methods: Electromyographic activity of wrist flexors and extensors (flexor carpi ulnaris and extensor digitorum) was recorded during maximal voluntary contraction of the affected and non-affected wrists. Co-contraction was calculated using the coactivation index and was expressed as percent activation of antagonist over agonist. Nine children (two girls and seven boys, 6 to 16 years of age) with congenital upper-limb deficiencies participated in this study and were fitted with a wrist-driven 3D printed prosthetic hand. From the nine children, five (two girls and three boys, 7 to 10 years of age) completed a second visit after using the wrist-driven 3D printed partial hand prosthesis for 6 months.Results: Separate two-way repeated measures ANOVAs were performed to analyze the coactivation index and strength data. There was a significant main effect for hand with the affected hand resulting in a higher coactivation index for flexion and extension than the non-affected hand. For wrist flexion there was a significant main effect for time indicating that the affected and non-affected hand had a significantly lower coactivation index after a period of 6 months.Conclusion: The use of a wrist-driven 3D printed hand prosthesis lowered the coactivation index by 70% in children with congenital upper limb reduction deficiencies. This reduction in coactivation and possible improvement in motor control strategies can potentially improve prosthetic rehabilitation outcomes. [ABSTRACT FROM AUTHOR]