Guidelines Help Amputees Perform Better
October 31, 2012

New Guidelines Could Help Amputees Perform Better

Lee Rannals for — Your Universe Online

A new progress tracking system could help to provide amputees the ability to perform everyday tasks better with their prosthetic arm.

A research team unveiled a new index that clinicians can use to asses their patients' progress and they described the process in the Archives of Physical Medicine and Rehabilitation.

Typically, amputee patients work with a team of doctors, prosthetists and therapists to learn how their limbs can help them regain function and quality of life. Clinicians have had few tools to assess whether the crucial teaching and learning process is going well due of a lack of standardized measurements to use with adults with upper limb amputations.

“Patients can´t just take a prosthesis out of the box and start using it skillfully,” lead author and physical therapist Linda Resnik said in a statement. “The upper limb is used to perform so many types of tasks. Patients need training to make the most of an upper limb prosthesis."

She said physical and occupational therapists train people to use adaptive equipment and prosthetic devices, teaching them strategies to accomplish tasks and guiding them in therapeutic exercises and activities.

"We need measures to let us know if our patients are improving the way that we expect them to," Resnik added. "When they get a new device, what are the benefits? Are they able to do more with it?”

The new standardized methods provide clinicians with the criteria to grade patients' performance, speed and skill using any kind of prosthetic arm to do 18 everyday tasks.

The tasks to perform according to the Activities Measure for Upper Limb Amputees (the AM-ULA) include anything from putting on and removing a shirt, opening a can of soda, combing hair, tying shoes, and using a spoon.

The researchers tested the metric with 49 veterans at facilities in Tampa and New York and the U.S. Army's Fort Sam Houston in Texas.

Resnik said patients do not tell clinicians everything they need to know, such as whether an amputee might use other body parts to compensate for an insufficiency with a prosthetic arm.

“This particular tool, because of the grading criteria that we use, considers aspects of movement quality that might not be picked up in a self report,” she said in the statement. “We look at the amount of body compensation used to perform a task — how much bending or use of other more proximal joints is involved in an activity. That´s important, because we know that upper limb amputees often develop problems in their neck and back.”

The team built the measure based on tasks from other measures and refined it iteratively using feedback from content experts.

One of the methods for refining the metric and ensuring its reliability was determining whether two independent raters arrived at the same ratings or strongly disagreed. They also determined when raters differed with themselves when the test was administered twice within a short period of time.

The researchers validated the measure by making sure the results made sense, based upon what was known clinically. AM-ULA scores were higher for people with amputation of the hand and lower for those with amputation above the elbow.

They analyzed the statistics to calculate how much of a change in the overall score could be considered more than just natural "noise" in the data.

“Outcome measures are needed in all areas of health care, but particularly so in the area of prosthetic rehabilitation,” Resnik said in the statement. “High tech prosthetic devices have great promise to help people regain function, but the costs for myoelectric and microprocessor prosthetic devices are substantially higher than those for simpler, body powered devices.”