OBJECTIVE: This study investigated whether the inclusion of video games in the upper limb amputee rehabilitation protocol could have a beneficial impact for muscle preparation, coordination, and patient motivation among individuals who have undergone transradial upper limb amputation.
METHODS: Ten participants, including five amputee participants and five able-bodied participants, were enrolled in 10 1-hour sessions within a 4-week rehabilitation program. In order to investigate the effects of the rehabilitation protocol used in this study, virtual reality box and block tests and electromyography (EMG) assessments were performed. Maximum voluntary contraction was measured before, immediately after, and 2 days after interacting with four different EMG-controlled video games. Participant motivation was assessed with the Intrinsic Motivation Inventory (IMI) questionnaire and user evaluation survey.
RESULTS: Survey analysis showed that muscle strength and coordination increased at the end of training for all the participants. The results of Pearson correlation analysis indicated that there was a significant positive association between the training period and the box and block test score (r8=0.95, P
METHODS: PubMed, Web of Science, and Google Scholar databases were explored to find related articles. Search terms were amputees, artificial limb, prosthetic suspension, prosthetic liner, vacuum, and prosthesis. The results were refined by vacuum socket or vacuum assisted suspension or sub-atmospheric suspension. Study design, research instrument, sample size, and outcome measures were reviewed. An online questionnaire was also designed and distributed worldwide among professionals and prosthetists (www.ispoint.org, OANDP-L, LinkedIn, personal email).
FINDINGS: 26 articles were published from 2001 to March 2016. The number of participants averaged 7 (SD=4) for transtibial and 6 (SD=6) for transfemoral amputees. Most studies evaluated the short-term effects of vacuum systems by measuring stump volume changes, gait parameters, pistoning, interface pressures, satisfaction, balance, and wound healing. 155 professionals replied to the questionnaire and supported results from the literature. Elevated vacuum systems may have some advantages over the other suspension systems, but may not be appropriate for all people with limb loss.
INTERPRETATION: Elevated vacuum suspension could improve comfort and quality of life for people with limb loss. However, future investigations with larger sample sizes are needed to provide strong statistical conclusions and to evaluate long-term effects of these systems.
BACKGROUND: Prosthesis should be donned and doffed few times during the day and night; thus, it is important to measure ease of donning and doffing.
STUDY DESIGN: A cross-sectional study.
METHODS: The questionnaire was designed and evaluated by a group of experts. The final questionnaire was administered to 50 individuals with trans-tibial amputation. A test-retest study was also conducted on 20 amputees to assess the repeatability of questionnaire items.
RESULTS: The prosthesis donning and doffing questionnaire was developed and tested through a pilot study. Based on Kappa index, the questionnaire items showed correlation coefficients greater than 0.7, which indicate good reliability and repeatability. The majority of the participants had good hand dexterity (80%) and could perform all types of grasps. The mean satisfaction scores with donning and doffing were 69.9 and 81.4, respectively. Most of the respondents needed to don and doff the prosthesis 3.44 times per day. Based on a 7-point score, the total scores ranged between 3 and 7.
CONCLUSION: The prosthesis donning and doffing questionnaire items showed good psychometric properties. A scoring method was suggested based on the pilot sample, which requires further evaluation to be able to differentiate between more suspension types. A larger international multicenter evaluation is required in the future to measure the responsiveness of the scales. This questionnaire will be useful in the evaluation of the ability of amputees to don and doff a trans-tibial limb prosthesis. Clinical relevance Donning and doffing of prostheses are challenging tasks for many lower limb amputees. The prosthesis donning and doffing questionnaire, on its own or combined with other prosthetic evaluation questionnaires, has the potential to help manufacturers, clinicians, and researchers gain knowledge and improve the donning and doffing qualities of prostheses.
EVIDENCE ACQUISITION: Searches were conducted with the Web of Science, Google Scholar, IEEE Xplore, and PubMed databases from inception up to September 2020. Articles that employed virtual reality in the rehabilitation of individual with upper limb loss were included in the research if it is written in English, the keyword exists in the title and abstract; it uses visual feedback in nonimmersive, semi-immersive, or fully immersive virtual environments. Data extraction was carried out by two independent researchers. The study was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA).
EVIDENCE SYNTHESIS: A total of 38 articles met the inclusion criteria. Most studies were published between 2010 and 2020. Thirty-nine percent of the studies (N.=15), originates from North America; 55% of the studies (N.=21), were publicly funded; 61% of the studies (N.=24), was without disclosure of conflict of interest; 82% of the studies (N.=31), were cited in other studies. All the studies were published in journals and conference proceedings. Sixty-six percent of the studies (N.=25) has come out with positive outcome. The design studies were mostly case reports, case series, and poorly designed cohort studies that made up 55% (N.=21) of all the studies cited here.
CONCLUSIONS: The research conducted on the use of virtual reality in individual with upper limb loss rehabilitation is of very low quality. The improvements to the research protocol are much needed. It is not necessary to develop new devices, but rather to assess existing devices with well-conducted randomized controlled trials.