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This article provides a comprehensive narrative review of physical task-based assessments used to evaluate the multi-grasp dexterity and functional impact of varying control systems in pediatric and adult upper-limb prostheses. Our search returned 1,442 research articles from online databases, of which 25 tests—selected for their scientific rigor, evaluation metrics, and psychometric properties—met our review criteria. We observed that despite significant advancements in the mechatronics of upper-limb prostheses, these 25 assessments are the only validated evaluation methods that have emerged since the first measure in 1948. This not only underscores the lack of a consistently updated, standardized assessment protocol for new innovations, but also reveals an unsettling trend: as technology outpaces standardized evaluation measures, developers will often support their novel devices through custom, study-specific tests. These boutique assessments can potentially introduce bias and jeopardize validity. Furthermore, our analysis revealed that current validated evaluation methods often overlook the influence of competing interests on test success. Clinical settings and research laboratories differ in their time constraints, access to specialized equipment, and testing objectives, all of which significantly influence assessment selection and consistent use. Therefore, we propose a dual testing approach to address the varied demands of these distinct environments. Additionally, we found that almost all existing task-based assessments lack an integrated mechanism for collecting patient feedback, which we assert is essential for a holistic evaluation of upper-limb prostheses. Our review underscores the pressing need for a standardized evaluation protocol capable of objectively assessing the rapidly advancing prosthetic technologies across all testing domains.
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A multiarticulate pediatric prosthetic hand for clinical and research applications
Although beginning to emerge, multiarticulate upper limb prostheses for children remain sparse despite the continued advancement of mechatronic technologies that have benefited adults with upper limb amputations. Upper limb prosthesis research is primarily focused on adults, even though rates of pediatric prosthetic abandonment far surpass those seen in adults. The implicit goal of a prosthesis is to provide effective functionality while promoting healthy social interaction. Yet most current pediatric devices offer a single degree of freedom open/close grasping function, a stark departure from the multiple grasp configurations provided in advanced adult devices. Although comparable child-sized devices are on the clinical horizon, understanding how to effectively translate these technologies to the pediatric population is vital. This includes exploring grasping movements that may provide the most functional benefits and techniques to control the newly available dexterity. Currently, no dexterous pediatric research platforms exist that offer open access to hardware and programming to facilitate the investigation and provision of multi-grasp function. Our objective was to deliver a child-sized multi-grasp prosthesis that may serve as a robust research platform. In anticipation of an open-source release, we performed a comprehensive set of benchtop and functional tests with common household objects to quantify the performance of our device. This work discusses and evaluates our pediatric-sized multiarticulate prosthetic hand that provides 6 degrees of actuation, weighs 177 g and was designed specifically for ease of implementation in a research or clinical-research setting. Through the benchtop and validated functional tests, the pediatric hand produced grasping forces ranging from 0.424–7.216 N and was found to be comparable to the functional capabilities of similar adult devices. As mechatronic technologies advance and multiarticulate prostheses continue to evolve, translating many of these emerging technologies may help provide children with more useful and functional prosthesis options. Effective translation will inevitably require a solid scientific foundation to inform how best to prescribe advanced prosthetic devices and control systems for children. This work begins addressing these current gaps by providing a much-needed research platform with supporting data to facilitate its use in laboratory and clinical research settings.
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- Award ID(s):
- 2133879
- PAR ID:
- 10465843
- Date Published:
- Journal Name:
- Frontiers in Robotics and AI
- Volume:
- 9
- ISSN:
- 2296-9144
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.3389/frobt.2022.1000159
