Article

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.

Langue : ANGLAIS