Comparison of range-of-motion and variability in upper body movements between transradial prosthesis users and able-bodied controls when executing goal-oriented tasks

Abstract

Background: Current upper limb prostheses do not replace the active degrees-of-freedom distal to the elbow inherent to intact physiology. Limited evidence suggests that transradial prosthesis users demonstrate shoulder and trunk movements to compensate for these missing volitional degrees-of-freedom. The purpose of this study was to enhance understanding of the effects of prosthesis use on motor performance by comparing the movement quality of upper body kinematics between transradial prosthesis users and able-bodied controls when executing goal-oriented tasks that reflect activities of daily living.

Methods: Upper body kinematics were collected on six able-bodied controls and seven myoelectric transradial prosthesis users during execution of goal-oriented tasks. Range-of-motion, absolute kinematic variability (standard deviation), and kinematic repeatability (adjusted coefficient-of-multiple-determination) were quantified for trunk motion in three planes, shoulder flexion/extension, shoulder ab/adduction, and elbow flexion/extension across five trials per task. Linear mixed models analysis assessed between-group differences and correlation analysis evaluated association between prosthesis experience and kinematic repeatability.

Results: Across tasks, prosthesis users demonstrated increased trunk motion in all three planes and shoulder abduction compared to controls (p ≤ 0.004). Absolute kinematic variability was greater for prosthesis users for all degrees-of-freedom irrespective of task, but was significant only for degrees-of-freedom that demonstrated increased range-of-motion (p ≤ 0.003). For degrees-of-freedom that did not display increased absolute variability for prosthesis users, able-bodied kinematics were characterized by significantly greater repeatability (p ≤ 0.015). Prosthesis experience had a strong positive relationship with average kinematic repeatability (r = 0.790, p = 0.034).

Conclusions: The use of shoulder and trunk movements by prosthesis users as compensatory motions to execute goal-oriented tasks demonstrates the flexibility and adaptability of the motor system. Increased variability in movement suggests that prosthesis users do not converge on a defined motor strategy to the same degree as able-bodied individuals. Kinematic repeatability may increase with prosthesis experience, or encourage continued device use, and future work is warranted to explore these relationships. As compensatory dynamics may be necessary to improve functionality of transradial prostheses, users may benefit from dedicated training that encourages optimization of these dynamics to facilitate execution of daily living activity, and fosters adaptable but reliable motor strategies.

Figures

Figure 1

Image of a prosthesis user in the position prior to the start of task (a), and at the start and end of task execution (b).

Figure 2

Group ensemble average kinematic profiles of able-bodied (average = dashed line) and prosthesis users (average = solid line; standard deviation = shaded band) executing task 3 (carton pouring). Neutral for all DoF angles is 0°, apart from elbow flexion where full extension is 180° and smaller values denote elbow flexion.

Figure 3

Group average RoM (maximum angle – minimum angle) for the carton pouring (a), weighted container transfer (b), and tray transfer tasks (c). Error bars represent the 95% confidence interval.

Figure 4

Group average SD for the carton pouring (a), weighted container transfer (b), and tray transfer tasks (c). Error bars represent the 95% confidence interval.

Figure 5

Group average CMD for the carton pouring (a), weighted container transfer (b), and tray transfer tasks (c). Error bars represent the 95% confidence interval.