Abstract
A major concern for upper-limb prosthesis users noted by prosthetists and OTs is rate of prosthesis rejection. The creation of the video program is one strategy to counteract this concern. The purpose of the program is to provide clients with an additional resource to learn and relearn how to complete daily tasks with their prosthesis. The program in place was designed to determine how effective and helpful the videos are for prosthesis users visiting Össur Touch Solutions.
Primary Author and Speaker: Veronica Balko
Contributing Authors: Richard Simpson, Lynsay Whelan
Throughout the United States there is a small population of individuals with an upper limb amputation. It has been noted that around 20% (Biddiss & Chau, 2007) to 33% (Datta, Selvarajah, & Davey, 2004) of upper limb amputees reject their prosthesis. Many factors, such as level of amputation, dissatisfaction with technology, poor training, and more can persuade individuals to disregard their device (Biddiss & Chau, 2007). To address the dilemma concerning prosthesis rejection, it is important for therapists to provide adequate training to ensure clients can control their device prior to activities of daily living (ADL) training.
A Quality Improvement project was conducted in an effort to increase the quality of care for individuals visiting the Össur Touch Solution facility that received a myoelectric prosthesis. The purpose of the capstone was to provide clients with an upper limb amputation an additional outside resource to learn how to control their prosthesis to complete daily activities after they graduated from the Touch Solutions facility. The first objective for this program was developing a sustainable video-based program by creating the videos and obtaining feedback from clients regarding their likes and dislike for the program. The second objective was showing improvements in assessment scores from the start of the week compared to the end and two weeks after the users returned home.
Cusack, Patterson, Thach, Kistenberg, and Wheaton (2014) noted improvements in motor performance for prosthesis users when observing and imitating a video of another user completing an activity with the same prosthesis. Users are better able to learn and understand how to control their device when observing and imitating another prosthesis user rather than a therapist with sound limbs. Chen and Wu (2015) found that incorporating both visual and auditory components to video guides was found to be the most effective learning strategy. Because of this, voice-overs to describe task completion in the videos were included to help walk the viewer through the process. After the initial videos were created, ten end users with partial hand amputations visiting Touch Solutions were recruited through convenience sampling to participate in the program. Demographic, satisfaction, and follow-up surveys along with three assessments (Patient-Specific Functional Scale, Southampton Hand Assessment Procedure, and a competency assessment) were administered to clients throughout their week long visit. These surveys and assessments helped to determine each clients’ performance with their device following education on the video program and their satisfaction with the program overall.
Results from the assessment data does not support the video program as there was minimal correlation between videos watched and increases in assessment scores. However, participants stated their satisfaction with the program as they found the videos easy to follow and understand and noted the wide variety of activities the tutorials covered. For future research, it will be helpful to implement the program again to gather data concerning its effectiveness when the video tutorials are included during training, rather than apart from it. This will help understand if the end users can recall the instructions from the tutorials to complete meaningful activities and improve their assessment scores. Additional research should be considered concerning how occupational therapists view the program and can utilize it to assist them while training end users to use their prosthesis for ADL.
Biddiss, E., & Chau, T. (2007). Upper-limb prosthetics: Critical factors in device abandonment. American Journal of Physical Medicine & Rehabilitation, 86(12), 977-987. doi:10.1097/PHM.0b013e3181587f6c
Chen, C. M., & Wu, C. H. (2015). Effects of different video lecture types on sustained attention, emotion, cognitive load, and learning performance. Computers & Education, 80, 108-121. https://doi.org/10.1016/j.compedu.2014.08.015
Cusack, W. F., Patterson, R., Thach, S., Kistenberg, R. S., & Wheaton, L. A. (2014). Motor performance benefits of matched limb imitation in prosthesis users. Experimental Brain Research, 232(7), 2143-2154. doi:10.1007/s00221-014-3904-2
Datta, D., Selvarajah, K., & Davey, N. (2004). Functional outcome of patients with proximal upper limb deficiency—acquired and congenital. Clinical Rehabilitation, 18, 172–177. doi:10.1191/0269215504cr716oa