- Email: [email protected]
Outcomes and evaluation in upper limb amputees
Annals of Physical and Rehabilitation Medicine 60S (2017) e33–e38
Available online at
ScienceDirect www.sciencedirect.com
Prosthetics and orthotics
CO094
Arthrodesis simulation orthosis, an alternative to surgical ankle arthrodesis in ankle osteoarthritis on walking pain by using the methodology of SCED Isabelle Loiret , Noël Martinet , Jean Paysant , Guillaume Bokobza ∗ , Anne-Gabrielle Franc¸ois Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France ∗ Corresponding author. E-mail address: [email protected] (G. Bokobza) Objective Ankle osteoarthritis (AO) is a usual long-term complication of ankle trauma. Pain during walking is the main symptom limiting walking distance. Non-surgical treatment including drugs, corticosteroid intra-articular injection or orthosis, could be used to decrease pain. The gold standard treatment of end stage of AO is the definitive surgical ankle arthrodesis. The purpose of this study is to prove the effectiveness of the hind foot stabilisation orthosis called “arthrodesis simulation” (AS) on the walking-pain and walking distance in a population suffering from ankle and/or hind foot osteoarthritis. Material/patients and methods A single case experimental design (SCED) with a structure (A1-B1-A2-B2) used randomly repeated measurements of a 2 MWT to determine changes at each phase of the study. Pain at the end of the 2 MWT using a visual analogue scale and the walking distance were evaluated by a blind assessor. One patient from Regional Rehabilitation Institute in Nancy (IRR, France) suffering from AO and wearing an AS daily, walked at fast speed during the 2MWT without AS during the 2 baseline phases (A1, A2) and with AS during the 2 intervention phases (B1, B2). Visual analysis, mean, trend and nonoverlap of all pairs (NAP) were calculated for both values for each phase. Results The average pain was significantly different between each phase (A1-B1-A2-B2) (Wilcoxon test). The pain NAP was 100% which corresponds to all data points assessing pain were greater during walking without AS. The pain trend increased with the measurement time without AS whereas the pain trend was stable, close to 0, with AS. The average walking distance was significantly different between each phase (A1-B1-A2-B2) (t-test). The walking distance NAP was close to 100% corresponding to all data points assessing walking distance were greater with AS. The walking distance trend increased faster with AS compared to without AS.
1877-0657/
Discussion, conclusion This SCED demonstrated the effectiveness of the AS on walking-pain and walking distance in people suffering from AO. Wearing AS increased walking distance during 2MWT without pain. Further SCEDs are necessary to confirm AS efficiency. This device, which is an orthopaedic treatment, could be an interesting alternative to surgical ankle arthrodesis. Keywords Arthrodesis simulation orthosis; Ankle osteoarthritis; Walking pain; SCED Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.003 CO095
Outcomes and evaluation in upper limb amputees
Isabelle Loiret , Rémi Leclaire ∗ , Noël Martinet , Jean Paysant Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France ∗ Corresponding author. E-mail address: [email protected] (R. Leclaire) Objective The reimbursement by French health care system of the new myoelectric devices with multiarticulated hands, requires assessment of the prehensile function. This evaluation could help rehab professionals to prescribe prosthesis among the different available devices for upper limb amputees. As well as in lower limb amputees, evaluation is organised according 3 axes: prosthesis assessment, amputee assessment, and the couple “amputee-prosthesis” assessment in terms of capability and disability. The aim of the study was to realize a review of the literature over the last 10 years to find the significant outcomes in upper limb amputees. Material/patients and methods Medline, Reedoc, Scopus were interviewed between January 2006 and March 2017 with the following words: upper limb amputee, upper limb amputation, survey, questionnaire, evaluation, assessment, outcome and their equivalent in French. Only studies in English and in French were selected. Only self-reports and clinical tests in adults and in children considering psychomotor development were included. Results Numerous outcomes (either generic or specific) were found. Most of them were only used by the validation team as the child specific UNB test. These outcomes cover a wide range of assessment: grip, monomanual and bimanual coordination grasp (considering psychomotor development), satisfaction, quality of life or body image. Box and Block Test (BBT), activities measure for
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Prosthetics and orthotics / Annals of Physical and Rehabilitation Medicine 60S (2017) e33–e38
upper limb amputees (AM-ULA) evaluating complete daily activities; Orthotics and Prosthetics Users Survey (OPUS) were the most commonly used outcomes. Southampton hand assessment procedure (SHAP) assesses the capabilities to realize tasks with the prosthesis. Any specific self-report is available in French. Disability of the Arm Shoulder and Hand scale (DASH), Abilhand test and Quebec Users Evaluation Satisfaction with Assistive Technology (QUEST) are the only nonspecific questionnaires available in French. Discussion, conclusion In upper limb amputees, assessment of the prehensile function is essential and imposed by French health care system to prescribe myoelectric prosthesis with multiarticulated hands. The clinical tests AM-ULA which have good psychometric properties and BBT could be used especially since the minimal detectable change (MDC) is known. SHAP is also interesting, however, MDC is unknown. The specific self-report OPUS should be validated in French and not just translated. Keywords Upper limb amputees; Clinical tests; Self-report; Assessment Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.004 CO096
Assessment of multigrip prosthetic hand by a crossover longitudinal study Isabelle Loiret 1,∗ , Valérie Sanamane 1 , Amélie Touillet 1 , Noël Martinet 1 , Jean Paysant 1 , Camille Fournier-Farley 2 , Anne-Gabrielle Franc¸ois 1 1 Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France 2 Institut de réadaptation Gingras-Lindsay-de-Montréal, université de Montréal, rééducation, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (I. Loiret) Objective The major function of the hand that the upper limb prosthesis tries to replicate is grasp. New myoelectric devices with multiarticulated hands are available and are reimbursed by French health care system. These devices propose several types of grip, which are getting closer to human hand movements. Few studies evaluated the impact of these devices on prehensile function. It is important for the rehabilitation team to know how upper limb amputees manage these devices in their daily lives to improve rehabilitation. The aim of this study was to evaluate the functional use of these new myoelectric prosthetic hand (NMPH) compared to tridigital myoelectric hand (TDMH). Material/patients and methods Eight unilateral transradial upper limb amputees (7 male, 1 female, age 39.5 ± 14 years old) wearing usually a myoelectric prosthesis participated in this prospective crossover study. Functional assessment was realized by each participant with their own tridigital myoelectric prosthesis and a multigrip prosthesis after specific rehabilitation and one month of home use. Self-report questionnaires included Quick DASH, Orthotics and Prosthetics Users Survey (OPUS) and the French version of the Quebec Users Evaluation Satisfaction with Assistive Technology (QUEST). Clinical tests included Box and Blocks Test (BBT) in sitting position, Southampton Hand Assessment Procedure (SHAP) and the third phase of Hand 400 points. These values were compared for each participant between both myoelectric prosthesis. Results There is no significant difference between both devices for manual dexterity (BBT), gripping capabilities (SHAP) and grasping capabilities, as assessed by the third phase of Hand 400 points which also visually evaluates shoulder and trunk compensations during the movement of the objects, and technology satisfaction (QUEST).
Discussion, conclusion In this study, the use of these new multiarticulated prosthetic hands did not influence the gripping capabilities at 1 month of home use. In the literature, an increased manual dexterity was found at 3 months of home use (Luchetti et al., JRRD 2015). However, these new devices providing several types of grip, may be of interest in decreasing shoulder or trunk compensations during grasp in upper limb amputees. Further studies are mandatory to objectively evaluate these compensations using optoelectronic systems and could be used for assessment of rehabilitation programs. Keywords Multigrip prosthetic hand; Tridigital myoelectric hand; Assessment; Clinical tests; Self-reports; Cross-over Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.005 CO097
Influence of end-effector on the risk of shoulder pathologies after forearm amputation: Use of the active shoulder abduction measurement
Amélie Touillet ∗ , Isabelle Loiret , Noël Martinet , Jean Paysant , Marie-Agnès Haldric , Valérie Sanamane Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France ∗ Corresponding author. E-mail address: [email protected] (A. Touillet) Objective After upper limb amputation, the use of prosthesis usually causes compensation movements for trunk and stump. These compensations can lead to musculoskeletal pain or overuse syndromes. In the context of occupational pathologies, stress levels were defined as at risk for shoulder concerning abduction amplitude (60◦ ) and duration of exposure (2/24 h or 8.5% of the time beyond 60◦ ). The objective of this study is to evaluate the risk of shoulder complications in a population of belowelbow amputees when using different myoelectric prosthetic end-effectors. Material/patients and methods Eight below-elbow amputees fitted with tridigital myoelectric prosthetic hand potential users of non-morphometric end-effectors in professional or leisure time are evaluated. Shoulder abduction (mean abduction and percentage of time spent beyond 60◦ of abduction) is measured during a Box and Block Test in a sitting position with a VICON optoelectronic system. The measurements are performed for amputated limb in 2 or 3 conditions: non-morphometric end-effector with or without wrist flexion-extension ± with tridigital myoelectric prosthetic hand (for 3 amputees) and for healthy limb. Results There is no significant difference in dexterity between end-effectors but significant difference between all end-effectors and healthy limb. The mean shoulder abduction is greater than 60◦ and the median percentage of time beyond 60◦ abduction is greater than 8.5% only when using a non-morphometric endeffector without wrist flexion-extension. Moreover, there is a significant difference between the 2 limbs for the mean abduction only with the non-morphometric effector without wrist flexionextension. There are no differences between the other end-effectors and healthy limb, nor between the end-effectors between them. Discussion, conclusion Prosthetic grip and mobility capacity of prosthetic wrist also influence shoulder kinematics. For some amputees, shoulder abduction is not at risk for musculoskeletal disorders but other compensation movements (internal shoulder rotation, trunk torso. . .) remain to be studied. The quantification of stresses on residual limb and trunk related to these compensations could allow to detect risk of musculoskeletal complications. A personalized analysis of compensations during common task could guide the choice of prosthetic end-effector and its adjustment and
Available online at
ScienceDirect www.sciencedirect.com
Prosthetics and orthotics
CO094
Arthrodesis simulation orthosis, an alternative to surgical ankle arthrodesis in ankle osteoarthritis on walking pain by using the methodology of SCED Isabelle Loiret , Noël Martinet , Jean Paysant , Guillaume Bokobza ∗ , Anne-Gabrielle Franc¸ois Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France ∗ Corresponding author. E-mail address: [email protected] (G. Bokobza) Objective Ankle osteoarthritis (AO) is a usual long-term complication of ankle trauma. Pain during walking is the main symptom limiting walking distance. Non-surgical treatment including drugs, corticosteroid intra-articular injection or orthosis, could be used to decrease pain. The gold standard treatment of end stage of AO is the definitive surgical ankle arthrodesis. The purpose of this study is to prove the effectiveness of the hind foot stabilisation orthosis called “arthrodesis simulation” (AS) on the walking-pain and walking distance in a population suffering from ankle and/or hind foot osteoarthritis. Material/patients and methods A single case experimental design (SCED) with a structure (A1-B1-A2-B2) used randomly repeated measurements of a 2 MWT to determine changes at each phase of the study. Pain at the end of the 2 MWT using a visual analogue scale and the walking distance were evaluated by a blind assessor. One patient from Regional Rehabilitation Institute in Nancy (IRR, France) suffering from AO and wearing an AS daily, walked at fast speed during the 2MWT without AS during the 2 baseline phases (A1, A2) and with AS during the 2 intervention phases (B1, B2). Visual analysis, mean, trend and nonoverlap of all pairs (NAP) were calculated for both values for each phase. Results The average pain was significantly different between each phase (A1-B1-A2-B2) (Wilcoxon test). The pain NAP was 100% which corresponds to all data points assessing pain were greater during walking without AS. The pain trend increased with the measurement time without AS whereas the pain trend was stable, close to 0, with AS. The average walking distance was significantly different between each phase (A1-B1-A2-B2) (t-test). The walking distance NAP was close to 100% corresponding to all data points assessing walking distance were greater with AS. The walking distance trend increased faster with AS compared to without AS.
1877-0657/
Discussion, conclusion This SCED demonstrated the effectiveness of the AS on walking-pain and walking distance in people suffering from AO. Wearing AS increased walking distance during 2MWT without pain. Further SCEDs are necessary to confirm AS efficiency. This device, which is an orthopaedic treatment, could be an interesting alternative to surgical ankle arthrodesis. Keywords Arthrodesis simulation orthosis; Ankle osteoarthritis; Walking pain; SCED Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.003 CO095
Outcomes and evaluation in upper limb amputees
Isabelle Loiret , Rémi Leclaire ∗ , Noël Martinet , Jean Paysant Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France ∗ Corresponding author. E-mail address: [email protected] (R. Leclaire) Objective The reimbursement by French health care system of the new myoelectric devices with multiarticulated hands, requires assessment of the prehensile function. This evaluation could help rehab professionals to prescribe prosthesis among the different available devices for upper limb amputees. As well as in lower limb amputees, evaluation is organised according 3 axes: prosthesis assessment, amputee assessment, and the couple “amputee-prosthesis” assessment in terms of capability and disability. The aim of the study was to realize a review of the literature over the last 10 years to find the significant outcomes in upper limb amputees. Material/patients and methods Medline, Reedoc, Scopus were interviewed between January 2006 and March 2017 with the following words: upper limb amputee, upper limb amputation, survey, questionnaire, evaluation, assessment, outcome and their equivalent in French. Only studies in English and in French were selected. Only self-reports and clinical tests in adults and in children considering psychomotor development were included. Results Numerous outcomes (either generic or specific) were found. Most of them were only used by the validation team as the child specific UNB test. These outcomes cover a wide range of assessment: grip, monomanual and bimanual coordination grasp (considering psychomotor development), satisfaction, quality of life or body image. Box and Block Test (BBT), activities measure for
e34
Prosthetics and orthotics / Annals of Physical and Rehabilitation Medicine 60S (2017) e33–e38
upper limb amputees (AM-ULA) evaluating complete daily activities; Orthotics and Prosthetics Users Survey (OPUS) were the most commonly used outcomes. Southampton hand assessment procedure (SHAP) assesses the capabilities to realize tasks with the prosthesis. Any specific self-report is available in French. Disability of the Arm Shoulder and Hand scale (DASH), Abilhand test and Quebec Users Evaluation Satisfaction with Assistive Technology (QUEST) are the only nonspecific questionnaires available in French. Discussion, conclusion In upper limb amputees, assessment of the prehensile function is essential and imposed by French health care system to prescribe myoelectric prosthesis with multiarticulated hands. The clinical tests AM-ULA which have good psychometric properties and BBT could be used especially since the minimal detectable change (MDC) is known. SHAP is also interesting, however, MDC is unknown. The specific self-report OPUS should be validated in French and not just translated. Keywords Upper limb amputees; Clinical tests; Self-report; Assessment Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.004 CO096
Assessment of multigrip prosthetic hand by a crossover longitudinal study Isabelle Loiret 1,∗ , Valérie Sanamane 1 , Amélie Touillet 1 , Noël Martinet 1 , Jean Paysant 1 , Camille Fournier-Farley 2 , Anne-Gabrielle Franc¸ois 1 1 Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France 2 Institut de réadaptation Gingras-Lindsay-de-Montréal, université de Montréal, rééducation, Montréal, Canada ∗ Corresponding author. E-mail address: [email protected] (I. Loiret) Objective The major function of the hand that the upper limb prosthesis tries to replicate is grasp. New myoelectric devices with multiarticulated hands are available and are reimbursed by French health care system. These devices propose several types of grip, which are getting closer to human hand movements. Few studies evaluated the impact of these devices on prehensile function. It is important for the rehabilitation team to know how upper limb amputees manage these devices in their daily lives to improve rehabilitation. The aim of this study was to evaluate the functional use of these new myoelectric prosthetic hand (NMPH) compared to tridigital myoelectric hand (TDMH). Material/patients and methods Eight unilateral transradial upper limb amputees (7 male, 1 female, age 39.5 ± 14 years old) wearing usually a myoelectric prosthesis participated in this prospective crossover study. Functional assessment was realized by each participant with their own tridigital myoelectric prosthesis and a multigrip prosthesis after specific rehabilitation and one month of home use. Self-report questionnaires included Quick DASH, Orthotics and Prosthetics Users Survey (OPUS) and the French version of the Quebec Users Evaluation Satisfaction with Assistive Technology (QUEST). Clinical tests included Box and Blocks Test (BBT) in sitting position, Southampton Hand Assessment Procedure (SHAP) and the third phase of Hand 400 points. These values were compared for each participant between both myoelectric prosthesis. Results There is no significant difference between both devices for manual dexterity (BBT), gripping capabilities (SHAP) and grasping capabilities, as assessed by the third phase of Hand 400 points which also visually evaluates shoulder and trunk compensations during the movement of the objects, and technology satisfaction (QUEST).
Discussion, conclusion In this study, the use of these new multiarticulated prosthetic hands did not influence the gripping capabilities at 1 month of home use. In the literature, an increased manual dexterity was found at 3 months of home use (Luchetti et al., JRRD 2015). However, these new devices providing several types of grip, may be of interest in decreasing shoulder or trunk compensations during grasp in upper limb amputees. Further studies are mandatory to objectively evaluate these compensations using optoelectronic systems and could be used for assessment of rehabilitation programs. Keywords Multigrip prosthetic hand; Tridigital myoelectric hand; Assessment; Clinical tests; Self-reports; Cross-over Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.005 CO097
Influence of end-effector on the risk of shoulder pathologies after forearm amputation: Use of the active shoulder abduction measurement
Amélie Touillet ∗ , Isabelle Loiret , Noël Martinet , Jean Paysant , Marie-Agnès Haldric , Valérie Sanamane Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France ∗ Corresponding author. E-mail address: [email protected] (A. Touillet) Objective After upper limb amputation, the use of prosthesis usually causes compensation movements for trunk and stump. These compensations can lead to musculoskeletal pain or overuse syndromes. In the context of occupational pathologies, stress levels were defined as at risk for shoulder concerning abduction amplitude (60◦ ) and duration of exposure (2/24 h or 8.5% of the time beyond 60◦ ). The objective of this study is to evaluate the risk of shoulder complications in a population of belowelbow amputees when using different myoelectric prosthetic end-effectors. Material/patients and methods Eight below-elbow amputees fitted with tridigital myoelectric prosthetic hand potential users of non-morphometric end-effectors in professional or leisure time are evaluated. Shoulder abduction (mean abduction and percentage of time spent beyond 60◦ of abduction) is measured during a Box and Block Test in a sitting position with a VICON optoelectronic system. The measurements are performed for amputated limb in 2 or 3 conditions: non-morphometric end-effector with or without wrist flexion-extension ± with tridigital myoelectric prosthetic hand (for 3 amputees) and for healthy limb. Results There is no significant difference in dexterity between end-effectors but significant difference between all end-effectors and healthy limb. The mean shoulder abduction is greater than 60◦ and the median percentage of time beyond 60◦ abduction is greater than 8.5% only when using a non-morphometric endeffector without wrist flexion-extension. Moreover, there is a significant difference between the 2 limbs for the mean abduction only with the non-morphometric effector without wrist flexionextension. There are no differences between the other end-effectors and healthy limb, nor between the end-effectors between them. Discussion, conclusion Prosthetic grip and mobility capacity of prosthetic wrist also influence shoulder kinematics. For some amputees, shoulder abduction is not at risk for musculoskeletal disorders but other compensation movements (internal shoulder rotation, trunk torso. . .) remain to be studied. The quantification of stresses on residual limb and trunk related to these compensations could allow to detect risk of musculoskeletal complications. A personalized analysis of compensations during common task could guide the choice of prosthetic end-effector and its adjustment and