About this trial
The investigators will test the following hypothesis: Use of Glide results in improved functional performance, satisfaction, and usage metrics as compared to use of a standard Direct Control (DC) prosthesis.
This study will compare the use of Glide \[Experimental\] prosthesis with a DC \[Standard\] prosthesis in a clinical setting and in unsupervised daily activity. We will follow a multiple baseline design, specifically an AB design. Each of the subjects will use the Experimental and Standard systems over a total of 24-weeks. The A phase is the baseline phase where the DC prosthesis will be used, and the B phase will be the treatment phase where the Glide prosthesis will be used. Participants will undergo an A phase of either 10-weeks, 12-weeks, or 14-weeks duration, with the remaining 14-, 12-, or 10-weeks of the study being dedicated to the B phase.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Trans-radial unilateral limb loss
Candidate for a multi-articulated myoelectric hand prosthesis as determined by the study prosthetist
Minimal residual limb length for myoelectric control as determined by the clinical team
Age of 18 years or greater
Disqualifiers
Patients with a residual limb that is unhealed from the amputation surgery
Patients with easily damaged or sensitive skin who would not tolerate EMG electrodes
Unhealed wounds
Significant cognitive deficits as determined upon clinical evaluation
Trial design
Single group
Treatments tested in this trial
Glide
DeviceGlide is a myoelectric prosthesis control strategy which enables multifunctional control using a limited set of input EMG signals (as few as two). The Glide control strategy uses the relative contributions of multiple electrode inputs to create a virtual cursor, calculated from a vector summation of multiple EMG channels, to select the type and speed of a movement from a circular map.
Direct Control
DeviceDirect Control (DC) is the most common method of control for powered prostheses, which directly links the activity recorded from a single electromyography (EMG) electrode to a prosthesis action. Typically, a pair of EMG electrodes are placed over a pair of agonist/antagonist muscle groups to operate a single DOF (e.g., for transradial amputees the flexor muscles in the forearm may be mapped to the prosthetic hand closing and the forearm extensor muscles mapped to hand opening).
Treatment groups
Trial outcomes
Primary outcomes
Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire (CAPROQ)
CAPROQ is a validated patient reported outcome measure that captures key facets of rehabilitation for adults with UL absence or loss: perceived function, satisfaction, and pain. CAPROQ includes a total of 28 questions spread across three sub-scales: 8 satisfaction, 10 perceived functioning, and 10 pain subcategory questions. Responses to all questions are given on a 10-point, Likert-type scale. Higher scores therefore indicate higher levels of overall satisfaction. A singular total CAPROQ score is derived by standardizing each of the CAPROQ subscales and summing these standardized scores together. Higher total scores on the CAPROQ indicate better rehabilitation outcomes and reflect the individual's perceived success with their prosthesis and rehabilitation; specifically, satisfaction with their prosthesis and rehabilitation, greater functional performance, and lesser pain. CAPROQ scores range from 0 to 100.
Secondary outcomes
Capacity Assessment of Prosthesis Performance of the Upper Limb (CAPPFUL)
CAPPFUL is a validated outcome measure designed as a versatile, low-burden measure of prosthesis performance for any UL functional prosthetic device type and any UL amputation level. CAPPFUL assesses overall performance and 5 functional performance domains during completion of 11 tasks. These require movement in all planes while manipulating everyday objects requiring multiple grasp patterns. Performance domains include control skill, adaptive and maladaptive compensatory movement, component utilization and time for task completion. CAPPFUL scores range from 0 to 100.
Targeted Box and Blocks Tests (tBBT)
tBBT allows for analysis of movement initiation, grasp, transport, and controlled release of objects. Participant performance in the tBBT is quantified by task completion time. A box with two compartments is used for this assessment. The blocks are arranged in a 4x4 array on the side of the testing hand, using an insert as a guide. Block colors and shapes are correlated to four different grip types available in prosthetic hands. Participants will be instructed to transport one block at a time, starting with the block closest to the partition in the row closest to the participant, placing the blocks in the mirrored position on the opposite side of the partition into target locations defined by an identical insert as on the side of the testing hand. The participant's score will be the time it takes to transport all 16 blocks. Administrators will also keep track of those blocks that are considered unsuccessful transports. tBBT scores start from 0 with no maximum value.
Daily Mean Number of Movement Bouts (DMNMB)
DMNMB is an objective measure collected by the controller. The controller does not send any outputs to the prosthesis when the control is in a "rest" state. For all other outputs, movement commands are sent to the prosthesis. Thus, the controller is in a good position to be able to record the amount of prosthesis usage as measured by the frequency of control signals. Such activity is measured in terms of series of continuous movement commands called "movement bouts." The number and length of movement bouts will be recorded and stored in the controller memory. Participants will report DMNMB weekly using a web-based portal.
Mean Prosthesis Wear Duration (MPWD)
MPWD measures the mean duration of daily prosthesis wear as a proxy for improved prosthesis acceptance. Prosthesis wear time is defined as the time from when subjects don their prostheses to the time they doff their prostheses and is self-reported by the participant. The log will be provided through a web-based portal and will be filled out weekly, each entry providing the prosthesis wear duration of the previous week.
Sponsors and contacts
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Infinite Biomedical Technologies
Lead sponsor
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Collaborator
Advanced Arm Dynamics
Collaborator