Sensory Feedback in Hand Prostheses: A Prospective Study of Everyday Use

Ulrika Wijk, Ingela K Carlsson, Christian Antfolk, Anders Björkman, Birgitta Rosén, Ulrika Wijk, Ingela K Carlsson, Christian Antfolk, Anders Björkman, Birgitta Rosén

Abstract

Introduction: Sensory feedback in hand prostheses is lacking but wished for. Many amputees experience a phantom hand map on their residual forearm. When the phantom hand map is touched, it is experienced as touch on the amputated hand. A non-invasive sensory feedback system, applicable to existing hand prostheses, can transfer somatotopical sensory information via phantom hand map. The aim was to evaluate how forearm amputees experienced a non-invasive sensory feedback system used in daily life over a 4-week period.

Methods: This longitudinal cohort study included seven forearm amputees. A non-invasive sensory feedback system was used over 4 weeks. For analysis, a mixed method was used, including quantitative tests (ACMC, proprioceptive pointing task, questionnaire) and interviews. A directed content analysis with predefined categories sensory feedback from the prosthesis, agency, body ownership, performance in activity, and suggestions for improvements was applied.

Results: The results from interviews showed that sensory feedback was experienced as a feeling of touch which contributed to an experience of completeness. However, the results from the questionnaire showed that the sense of agency and performance remained unchanged or deteriorated. The ability to feel and manipulate small objects was difficult and a stronger feedback was wished for. Phantom pain was alleviated in four out of five patients.

Conclusion: This is the first time a non-invasive sensory feedback system for hand prostheses was implemented in the home environment. The qualitative and quantitative results diverged. The sensory feedback was experienced as a feeling of touch which contributed to a feeling of completeness, linked to body ownership. The qualitative result was not verified in the quantitative measurements.

Clinical trial registration: Name: Evaluation of a Non-invasive Sensory Feedback System in Hand Prostheses. Date of registration: March 15, 2019. Date the first participant was enrolled: April 1, 2015. ClinicalTrials.gov Identifier: NCT03876405 ORCID ID: https://orcid.org/0000-0002-4140-7478.

Keywords: amputation; amputation stumps; artificial arm; sensory feedback; traumatic amputation; upper limb.

Copyright © 2020 Wijk, Carlsson, Antfolk, Björkman and Rosén.

Figures

FIGURE 1
FIGURE 1
When the silicon bulbs in the fingertips were pressed, the air was transferred via plastic tubes that reached actuators inside the prosthetic socket and gave pressure (mechanotactile feedback) on the skin corresponding with the PHM zones.
FIGURE 2
FIGURE 2
In the Proprioceptive pointing task the participants were asked, with their eyes closed, to mark on a ruler (proximally to distally from their own body) with their index finger on the sound hand, where they estimated the location of: (1) the prosthetic index finger and (2) where they experienced their phantom index finger.
FIGURE 3
FIGURE 3
On the x-axis each question has a column and the questions are grouped according to concept. The y-axis presents each participant and the Likert scale. The answers pre- and post- are illustrated with an arrow for each question and participant; an improvement is illustrated by a green arrow, an impairment by a red arrow, and if there was no change the arrow is blue (Question PLP1–PLP2 for homogeneity in the table, a high value [3] indicates less pain). The six control questions are not presented in the figure. Wilcoxon signed rank test showed a significant positive change regarding Sensory feedback (p = 0.031), a significant negative change regarding Agency (p = 0.023), and Performance in Activity (p = 0.007). No significant changes were seen in the other concept categories in the questionnaire.
FIGURE 4
FIGURE 4
The ACMC-scores for each participant at pre-tests and follow-up.

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