Multi-Articulating Myo-Electric Prostheses

Report
Multi-Articulating
Myo-Electric Prostheses
- Impact on Upper Limb
Amputee Function
Claire Owen
Specialist Occupational Therapist
10th November 2014
Amputee Rehabilitation, RNOH
Contents
• What is a myo-electric prosthesis?
• History of MEPs
• Current NHS provision
• RNOH Trials
• Evaluation
What is a Myo-Electric Prosthesis (MEP)?
An externally powered artificial limb that is controlled with the
electrical signals generated naturally by the user’s own muscles
o Electrodes in the socket pick up minute electrical impulses from
voluntary muscle contractions in the residual limb.
o These signals are amplified
and transmitted to the
motor/s to produce the
desired movement
o Power is provided by a
rechargeable, integrated
battery
History of MEPs - Not new technology!
1980s
1943
Early 2000s
2007
Provision
o Prior to April 2014 applications could be made to a
patient’s PCT
o Since April 2014 prosthetic provision has been
categorised as a specialist service and is commissioned
nationally under D.01 Complex Disability Equipment
o Provision policies are still be written and approved
o Therefore some centres are choosing to provide from
their centre budget
o At RNOH we have completed 5 trials with the Bebionic
Hand by RSL Steeper.
RNOH “Bebionic” Trials
o The Bebionic Hand was chosen by the MDT due to competitive pricing.
o RSL Steepers agreed to loan hands to patients for 2-4 week trials.
o 5 Patient trials have been carried out to date.
o 4 of the 5 patients decided to continue with the Bebionic post trial.
Patient Population
o Trans-radial amputees
o Male
o Aged between 32 years and 48 years in full time employment
o X 4 congenital limb absence and X 1 amputation due to
sarcoma
o 2 patients wore standard myo-electric prostheses
o 2 patients wore cosmetic (passive function) prostheses
o 1 patient wore a body powered split hook
Occupational Therapy Training
•
Myo-site testing and pre-prosthetic training. Ensure patients can:
- give 2 strong and consistent signals
- can differentiate between signals
- can voluntarily vary intensity of signal
- move arm in space without involuntarily giving signal
•
Prosthetic training
- introduction to the hand (don/doff, wearing schedule, care and
maintenance, positioning and posture)
- open and closing hand
- manual thumb positioning
- different grip patterns and how to access
- basic grasp and release tasks
- grasp and release in different functional planes
- Unilateral ADL tasks e.g holding phone, cutlery, carrying objects
- Bilateral ADL tasks e.g cooking, dressing, handling money
- Patient specific ADL tasks e.g work or leisure related
Outcome Measures
o DASH (Disability of the arm shoulder and hand)
30 item self report questionnaire which measures physical
function and symptoms
o PSFS (Patient Specific Functional Scale)
Identifies several activities specific to that patient, their ability to
carry out each activity is then rated on a scale of 0-10 (0=
unable, 10=fully able)
o EQ-5D-5L (EuroQol, 2011)
Standardised measure of health status. 5 sections relate to
mobility, self-care, ability to carry out usual activities,
pain/discomfort and anxiety and depression. Includes self-rated
heath score out of 100.
Results - DASH
DASH work Scores
DASH Leisure Scores
Patient Specific Function Scale
Comparison
between
Prostheses
A
B
C
D
E
No Prosthesis Vs
Previous Prosthesis
3.7
0
9
6.3
4.2
No Prosthesis Vs
Bebionic
6.7
3.8
4
6
Previous Prosthesis
Vs Bebionic
6.7
3.8
0.5
2.3
Patient
A
B
C
D
E
Previous Prescription
Cosmetic
Myoelectric
Myoelectric
Body powered split hook
Cosmetic
5
0.8
EQ-5D-5L
Change in EQ-5D Score
Change in Self-Care
No. of Patients
No. of Patients
5
4
3
2
1
0
-1.4
-1
-0.6
-0.2
0.2
0.6
Worsened
1
6
5
4
3
2
1
0
1.4
4
Improved
1
0
-1
-2
-3
-4
Improved
Change in Anxiety/ Depression
6
5
4
3
2
1
0
5
No. of Patients
No. of Patients
2
Worsened
Change in Mobility
4
3
2
1
0
4
3
2
1
0
-1
-2
Worsened
-3
-4
4
Improved
3
2
1
0
-1
-2
Worsened
-3
-4
Improved
Change in Pain/Discomfort
Change in Usual Activites
5
No. of Patients
5
No. of Patients
3
4
3
2
1
4
3
2
1
0
0
4
3
Worsened
2
1
0
-1
-2
-3
-4
Improved
4
3
Worsened
2
1
0
-1
-2
-3
-4
Improved
Anecdotal Evidence
At work I often
carry a bag with
the bionic hand,
freeing up my
other hand to use
a phone or
umbrella
I'm confident enough
to carry a full glass in
the bionic hand so
can carry 2 drinks at a
time without a tray
On the tube I can
hold onto a pole
with it and read
standing up
Generally I can carry
more (laptop in one
hand, papers in the
bionic hand) including
moderately heavy bags.
Bags are easier to grip
compared with my other
myo
I can hold the
shopping in my
Bebionic which frees
up my other hand to
hold my child’s hand
Preparing food is easier
(chopping for example)
as I can hold things
steady. It has a wider
grip than my other myo
so I can hold larger items,
e.g loaf of bread
I can unclip my
seatbelt with the
Bebionic, which I
couldn’t with other myo
as the fingers didn’t
straighten enough, this
prevents me twisting to
use sound hand and
helps my back
I've played pool
(moderately
successfully) which
was fun
I was able to lift a
barbecue up and
move it. Not that
heavy but wide so
my bionic hand
enabled me to grip it
securely
I can hold the hoover
cable, would have
slipped through
previous myo hand
Summary
• 4 out of 5 patients showed an improvement on DASH scores
with the Bebionic
•
All patients rated an increase in their chosen activities on
the PSFS with the Bebionic (3/5 of which were statistically
significant)
• The EQ-5D-5L only showed an improvement for 1 patient
• 4 of the 5 patients choose to be fit with the Bebionic
• One patient decided to stay with previous myo. This was
due to the additional weight of Bebionic (90g) and found he
didn’t actually use additional grips that Bebionic offered
Evaluation
On the whole the hand was positively received by patients and they felt the
hand gave them functional improvements.
Patient’s seem to like the improved confidence in the grip compared with
standard myo, more than the ability to access multiple different grips.
The outcome measures used did not capture the possible psychological
benefits of the hand, which for one patient in particular were profound.
A larger study of different multi-articulating hands is needed to establish
functional differences between the hands
Future trials need to consider which outcome measures will be sensitive
enough to show subtle differences between prosthetic hand functions.
What is more important, statistically significant functional improvements or
clinically significant functional improvements for an individual patient?
References
o EuroQol Group. EuroQol—a new facility for the measurement of healthrelated quality of life. Health Policy. 1990; 19: 199–208
o Hudak P, Amadio PC, Bombardier C, and the Upper Extremity Collaborative
Group. Development of an Upper Extremity Outcome Measure: The DASH
(Disabilities of the Arm, Shoulder, and Hand). American Journal of Industrial
Medicine 1996; 29:602-608
o Stratford, P., Gill, C., Westaway, M., & Binkley, J. (1995). Assessing
disability and change on individual patients: a report of a patient specific
measure. Physiotherapy Canada, 47, 258-263
Thank you for listening
Cost of Different Myo-Electric Prostheses
Manufacturer
Cost
Standard Myos
Steeper Myo
RSL Steeper
£1,995
DMC Plus
Otto Bock
£3,197
Sensorhand Speed
Otto Bock
£4,711
Bebionic
RSL Steeper
£6,444
I limb Ultra
Touchbionics
£15,600
Michelangelo
Otto Bock
Multi-articulating Myos
£30,000?
DIMENSIONS
EQ-5D-5L - (Descriptive system - produces 'health states')
Under each heading, please tick the ONE box that best describes your health TODAY
MOBILITY
I have no problems in walking about
I have slight problems in walking about
I have moderate problems in walking about
I have severe problems in walking about
I am unable to walk about
1
2
3
4
5
SELF-CARE
I have no problems washing or dressing myself
I have slight problems washing or dressing myself
I have moderate problems washing or dressing myself
I have severe problems washing or dressing myself
I am unable to wash or dress myself





USUAL ACTIVITIES (e.g. work, study, housework,
family or leisure activities)
I have no problems doing my usual activities
I have slight problems doing my usual activities
I have moderate problems doing my usual activities
I have severe problems doing my usual activities
I am unable to do my usual activities





PAIN / DISCOMFORT
I have no pain or discomfort
I have slight pain or discomfort
I have moderate pain or discomfort
I have severe pain or discomfort
I have extreme pain or discomfort





ANXIETY / DEPRESSION
I am not anxious or depressed
I am slightly anxious or depressed
I am moderately anxious or depressed
I am severely anxious or depressed
I am extremely anxious or depressed






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