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Using a Survey to Characterize Rehabilitation Professionals' Perceptions and Use of Complementary, Integrative, and Alternative Medicine

Kim, Sonya; Capo-Lugo, Carmen; Reed, William R; Vora, Ariana; Ehsanian, Reza; Krishnan, Shilpa; Hu, Xiaolei; Galantino, Mary Lou; Mortera, Marianne H; Beattie, Aaron; Sasson, Nicole; Theodore, Brian R; Erb, Matt; Heyn, Patricia
PMID: 32302490
ISSN: 1557-7708
CID: 4401832

Function, quality of life, and community integration of DEKA Arm users after discharge from prosthetic training: Impact of home use experience

Resnik, Linda; Acluche, Frantzy; Borgia, Matthew; Cancio, Jill; Latlief, Gail; Sasson, Nicole
BACKGROUND:Research on adaptation to advanced upper limb prostheses is needed. OBJECTIVES/OBJECTIVE:To (1) examine change in function, quality of life and community integration after prosthetic training, (2) determine whether change in outcomes varied by prosthesis complexity, and (3) compare patterns of change at 1 month for those who withdrew from the study and those who did not. STUDY DESIGN/METHODS:Quasi-experimental time series. METHODS:Data were analyzed for 22 participants (18 completers). Performance and self-report outcome measures were collected after in-laboratory training (Part A) and every 4 weeks of home use (Part B). Outcomes from End of A to End of B were compared statistically. Outcomes across assessments and by configuration level were compared graphically. Changes in scores were compared graphically for completers and non-completers. RESULTS:Quality of life scores did not change between End of A and End of B, whereas scores improved for one activity measure, two measures of self-reported function, and three dexterity measures ( p < 0.05). Outcomes of community integration, self-reported function, four dexterity measures, and one activity measure varied by prosthesis level. For participants who withdrew early, dexterity and activity scores worsened, perceived disability increased, and prosthesis satisfaction decreased after 4 weeks of home use. CONCLUSION/CONCLUSIONS:Study completers adapted to the DEKA Arm. Clinical relevance Findings suggest that for the majority of upper limb amputees discharged from prosthetic rehabilitation, function continues to improve with home use. However, a minority experience a decline in function, greater perceived disability, and greater dissatisfaction after 4 weeks, suggesting a need for continued therapy after intensive prosthetic training ends.
PMID: 29779455
ISSN: 1746-1553
CID: 3129662

Predictors of retention and attrition in a study of an advanced upper limb prosthesis: implications for adoption of the DEKA Arm

Resnik, Linda; Cancio, Jill; Klinger, Shana; Latlief, Gail; Sasson, Nicole; Smurr-Walters, Lisa
PURPOSE: The purpose was to identify factors associated with completion of the VA home study of the DEKA Arm. Design and methodological procedures used: Differences between groups were examined using chi-square and t-tests. A multivariable logistic regression model predicting completion was generated and odds ratios (OR) for significant variables calculated. Post-hoc analysis was performed to plot the receiver operating characteristics (ROC) curve. RESULTS: Participants who completed were more likely to be prosthesis users at study onset (p = .03), and less likely to have a history of musculoskeletal problems (p = .047). There were no statistically significant differences between groups who completed and those who did not in gender, race, veteran status, age, body mass index (BMI), weight, height, musculoskeletal pain at baseline, satisfaction with current prosthesis, type of prosthesis, or months of prosthesis use. Two variables, prosthesis use and history of musculoskeletal problems were significant at p < .10. The area under the curve (AUC) accuracy index was 0.78. CONCLUSIONS: We considered completion of the home use study a reasonable proxy for participant willingness to adopt the device; and believe that findings can be extrapolated to guide DEKA Arm prescription recommendations. Participants most likely to complete the study were already using a personal prosthesis, and without pre-existing musculoskeletal problems. Implications for rehabilitation Data from the VA Study of the DEKA Arm were analysed to determine which factors were associated with likely successful adoption of the DEKA Arm. Participants most likely to complete the study were those who already using a personal prosthesis, and those without pre-existing chronic or re-occurring musculoskeletal problems. This information may be useful when attempting to identify and target the most appropriate candidates for DEKA Arm prescription.
PMID: 28375687
ISSN: 1748-3115
CID: 2521432

How do the outcomes of the DEKA Arm compare to conventional prostheses?

Resnik, Linda J; Borgia, Matthew L; Acluche, Frantzy; Cancio, Jill M; Latlief, Gail; Sasson, Nicole
OBJECTIVES/OBJECTIVE:Objectives were to 1) compare self-reported function, dexterity, activity performance, quality of life and community integration of the DEKA Arm to conventional prostheses; and 2) examine differences in outcomes by conventional prosthesis type, terminal device type and by DEKA Arm configuration level. METHODS:This was a two-part study; Part A consisted of in-laboratory training. Part B consisted of home use. Study participants were 23 prosthesis users (mean age = 45 ± 16; 87% male) who completed Part A, and 15 (mean age = 45 ± 18; 87% male) who completed Parts A and B. Outcomes including self-report and performance measures, were collected at Baseline using participants' personal prostheses and at the End of Parts A and B. Scores were compared using paired t-tests. Wilcoxon signed-rank tests were used to compare outcomes for the full sample, and for the sample stratified by device and terminal device type. Analysis of outcomes by configuration level was performed graphically. RESULTS:At the End of Part A activity performance using the DEKA Arm and conventional prosthesis was equivalent, but slower with the DEKA Arm. After Part B, performance using the DEKA Arm surpassed conventional prosthesis scores, and speed of activity completion was equivalent. Participants reported using the DEKA Arm to perform more activities, had less perceived disability, and less difficulty in activities at the End of A and B as compared to Baseline. No differences were observed in dexterity, prosthetic skill, spontaneity, pain, community integration or quality of life. Comparisons stratified by device type revealed similar patterns. Graphic comparisons revealed variations by configuration level. CONCLUSION/CONCLUSIONS:Participants using the DEKA Arm had less perceived disability and more engagement of the prosthesis in everyday tasks, although activity performance was slower. After home use experience, activity performance was improved and activity speed equivalent to using conventional prostheses.
PMID: 29342217
ISSN: 1932-6203
CID: 2915482

EMG pattern recognition compared to foot control of the DEKA Arm

Resnik, Linda J; Acluche, Frantzy; Borgia, Matthew; Cancio, Jill; Latlief, Gail; Phillips, Samuel; Sasson, Nicole
INTRODUCTION/BACKGROUND:EMG pattern recognition control (EMG-PR) is a promising option for control of upper limb prostheses with multiple degrees of freedom (DOF). The purposes of this study were to 1) evaluate outcomes of EMG-PR and inertial measurement units (IMU) control of the DEKA Arm as compared to personal prosthesis; and 2) compare outcomes of EMG-PR to IMU control of DEKA Arm. METHODS:This was a quasi-experimental, multi-site study with repeated measures that compared non-randomized groups using two types of controls: EMG-PR and IMUs. Subjects (N = 36) were transradial (TR) and transhumeral (TH) amputees. Outcomes were collected at Baseline (using personal prosthesis), and after in-laboratory training (Part A), and home use (Part B). Data was compared to personal prosthesis, stratified by amputation level and control type. Outcomes were also compared by control type. RESULTS:The EMG-PR group had greater prosthesis use after Part A, but worse dexterity, lower satisfaction, and slower activity performance compared to Baseline; the IMU group had slower activity performance. After Part B, the EMG-PR group had less perceived activity difficulty; the IMU group had improved activity performance, improved disability and activity difficulty, but slower performance. No differences were observed for TH group by control type in Part A or B. The TR group using EMG-PR had worse dexterity (Parts A & B), and activity performance (Part A) as compared to IMU users. DISCUSSION/CONCLUSION/CONCLUSIONS:Findings suggest that for the TR group that IMUs are a more effective control method for the DEKA Arm as compared to the EMG-PR prototypes employed in this study. Further research is needed to refine the EMG-PR systems for multi-DOF devices. Future studies should include a larger sample of TH amputees. TRIAL REGISTRATION/ NCT01551420.
PMID: 30335781
ISSN: 1932-6203
CID: 3369812

Complementary and Integrative Medicine Utilization Among Rehabilitation Professionals: Attitudes and Practice

Kim, Sonya; Theodore, Brian; Capo-Lugo, Carmen; Krishnan, Shilpa; Ehsanian, Reza; Hu, Xiaolei; Beatie, Aaron; Vora, Ariana; Mortera, Marianne; Chan, Sophia; Sasson, Nicole; Tyson, Allan; Ginsberg, Jp; Appel, Philip; Tibbett, Jacqueline; Heyn, Patricia
ISSN: 0003-9993
CID: 3629952

Appropriateness of advanced upper limb prosthesis prescription for a patient with cognitive impairment: a case report

Barredo, Jennifer; Acluche, Frantzy; Disla, Roxanne; Fantini, Christopher; Fishelis, Leah; Sasson, Nicole; Resnik, Linda
PURPOSE: To describe a participant with scapulo-thoracic amputation and cognitive impairment trained to use the DEKA Arm and discuss factors relevant to the determination that he was not an appropriate candidate for independent home use of the device. METHOD: The participant underwent 40 h of in-laboratory training with the DEKA Arm Advanced Upper Limb Prosthesis. Pre-training neuropsychological measures of cognition were collected. Qualitative and quantitative data related to functional performance, quality of life and pain were collected after 10 h of training, and at the conclusion of training. Using a constant comparative approach, data were binned into major themes; elements within each theme were identified. RESULTS: Six themes were relevant to the determination that the participant was inappropriate for home use of the DEKA Arm: physical and mental health; learning, memory and cognition; adult role function; functional performance; user safety and judgement and capacity for independent device use. Issues contraindicating unsupervised device use included: uncontrolled health symptoms, poor knowledge application, safety concerns, absenteeism and performance degradation under stress. CONCLUSION: The findings have implications for training with and prescription of the DEKA Arm and other complex upper limb prostheses. Further research is needed to develop a model to guide prescription of technologically complex upper limb prostheses. Implications for Rehabilitation Advanced upper limb prostheses, like the DEKA Arm, promise greater functionality, but also may be cognitively demanding, raising questions of when, and if, prescription is appropriate for patients with cognitive impairment. At this time, no formal criteria exist to guide prescription of advanced upper limb prostheses. Each clinical team applies their own informal standards in decision-making. In this case report, we described six factors that were considered in determining whether or not a research participant, with scapulo-thoracic amputation and cognitive impairment was appropriate for home use of a complex upper limb prosthesis. The findings have implications for training with and prescription of the DEKA Arm, and highlights the need for further research to develop prescription guidelines for advanced assistive devices.
PMID: 27434169
ISSN: 1748-3115
CID: 2593242

Use of the DEKA Arm for amputees with brachial plexus injury: A case series

Resnik, Linda; Fantini, Christopher; Latlief, Gail; Phillips, Samuel; Sasson, Nicole; Sepulveda, Eve
OBJECTIVE: Patients with upper limb amputation and brachial plexus injuries have high rates of prosthesis rejection. Study purpose is to describe experiences of subjects with transhumeral amputation and brachial plexus injury, who were fit with, and trained to use, a DEKA Arm. METHODS: This was a mixed-methods study utilizing qualitative (e.g. interview, survey) and quantitative data (e.g. self-report and performance measures). Subject 1, a current prosthesis user, had a shoulder arthrodesis. Subject 2, not a prosthesis user, had a subluxed shoulder. Both were trained in laboratory and participated in a trial of home use. Descriptive analyses of processes and outcomes were conducted. RESULTS: Subject 1 was fitted with the transhumeral configuration (HC) DEKA Arm using a compression release stabilized socket. He had 12 hours of prosthetic training and participated in all home study activities. Subject 1 had improved dexterity and prosthetic satisfaction with the DEKA Arm and reported better quality of life (QOL) at the end of participation. Subject 2 was fit with the shoulder configuration (SC) DEKA Arm using a modified X-frame socket. He had 30 hours of training and participated in 3 weeks of home activities. He reported less functional disability at the end of training as compared to baseline, but encountered personal problems and exacerbation of PTSD symptoms and withdrew from home use portion at 3 weeks. Both subjects reported functional benefits from use, and expressed a desire to receive a DEKA Arm in the future. DISCUSSION: This paper reported on two different strategies for prosthetic fitting and their outcomes. The advantages and limitations of each approach were discussed. CONCLUSION: Use of both the HC and SC DEKA Arm for patients with TH amputation and brachial plexus injury was reported. Lessons learned may be instructive to clinicians considering prosthetic choices for future cases.
PMID: 28628623
ISSN: 1932-6203
CID: 2603812

Do users want to receive a DEKA Arm and why? Overall findings from the Veterans Affairs Study to optimize the DEKA Arm

Resnik, Linda; Latlief, Gail; Klinger, Shana L; Sasson, Nicole; Walters, Lisa S
Background:The purposes of this article are (1) to report on the overall desirability of the DEKA Arm by prototype and by level of prosthesis, (2) to report on user-perceived benefits of the DEKA Arm as compared to their current prostheses, and (3) to summarize user concerns about taking the device home.Study design:Qualitative content analysis of data from a multiple case study design.Methods:This study utilized data from 24 upper-limb amputees fit with a Gen 2 DEKA Arm and 13 fit with a Gen 3 DEKA Arm. Surveys were administered after fitting the DEKA Arm and at the end of training. Subjects recorded audiotaped comments about their experiences. All study sessions were videotaped.Results:In all, 79% of Gen 2 and 85% of Gen 3 users indicated that either they wanted to receive or might want to receive a DEKA Arm. In total, 95% of Gen 2 and 91% of Gen 3 prior prosthesis users reported that they were able to perform new activities that they were unable to perform with their own device.Conclusions:A large majority of subjects wanted a DEKA Arm, although desirability varied by amputation level.Clinical relevanceThe majority of amputees in this study expressed a desire to receive the DEKA Arm, a device which provides multiple powered degrees of freedom and is operated predominantly by foot controls. The majority reported functional advantages of the DEKA Arm over their existing prostheses.
PMID: 24286806
ISSN: 0309-3646
CID: 823192

Self-reported and performance-based outcomes using DEKA Arm

Resnik, Linda; Borgia, Matthew; Latlief, Gail; Sasson, Nicole; Smurr-Walters, Lisa
Mechanical properties of the DEKA Arm and associated engineering innovations are easy to observe. What is less clear is how these advances translate into functional benefits for the user with amputation. Study aims were to (1) quantify outcomes including dexterity, performance of daily activities, and prosthetic skill and spontaneity of users of the DEKA Arm and (2) compare outcomes when using the DEKA Arm with scores using the existing prosthesis. This was a quasi-experimental study. Descriptive analyses examined outcomes by DEKA Arm configuration level. Of the 39 subjects fit with a DEKA Arm, 32 were trained in use and completed end-of-study testing. Data from 26 prosthetic users were used to compare outcomes using existing prostheses with outcomes with the DEKA Arm. Dexterity and activity performance with the DEKA Arm varied by amputation level (p < 0.01). Self-reported function and number of activities performed using the prosthesis were similar across levels. Comparisons with existing prostheses showed the effect on dexterity varied by level. Activity performance and spontaneity of prosthetic use improved for users of the shoulder configuration level, while use of the prosthesis to perform activities and perceived difficulty performing self-selected tasks improved for all levels.
PMID: 25019659
ISSN: 0748-7711
CID: 1073872