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To coordinate the redundant degrees of freedom (DOF) in the action system, synergies are often proposed. Synergies organize DOF in temporary task-specific units emerging from interactions among task, organism, and environmental constraints. We examined whether task constraints affect synergies, end-effector kinematics, or both. To this end, we compared synergies and end-effector kinematics when participants (N = 15) performed discrete movements of identical amplitude in manual reaching (stationary targets) and manual lateral interception (moving targets, with different angles of approach). We found that time-velocity profiles were roughly symmetric in reaching, whereas they had a longer decelerative tail and showed an angle-of-approach effect in interception. Uncontrolled manifold analyses showed that in all conditions joint angle variability was primarily covariation, indicating a synergistic organization. The analysis on the clusters of joint angle configurations demonstrated differences between reaching and interception synergies, whereas more similar synergies were used within interception conditions. This implies that some task constraints operate at the level of synergies while other task constraints only affect end-effector kinematics. The results support a 2-step process in the organization of DOF, consisting of synergy formation and further constraining of synergies to produce the actual movement, as proposed by Kay (1988). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Many research initiatives have been employed in upper limb prosthetics (ULP) in the last few decades. The body of knowledge is growing and inspired by new and interesting technology that has been brought to the market to facilitate functioning of people with upper limb defects. However, a lot of research initiatives do not reach the target population. Several reasons can be identified as to why research does not move beyond the lab, such as lack of research quality, disappointing results of new initiatives, lack of funding to further develop promising initiatives, and poor implementation or dissemination of results. In this paper, we will appraise the current status of the research in ULP. Furthermore, we will try to provide food for thought to scale up research in ULP, focusing on (1) translation of research findings, (2) the quality of innovations in the light of evidence-based medicine and evidence-based practice, (3) patient involvement, and (4) spreading of research findings by focusing on implementation and dissemination of results and collaboration in a national and international perspective. With this paper, we aim to open the discussion on scaling up research in the community of professionals working in the field of ULP.

The ubiquity of tool use in human life has generated multiple lines of scientific and philosophical investigation to understand the development and expression of humans' engagement with tools and its relation to other dimensions of human experience. However, existing literature on tool use faces several epistemological challenges in which the same set of questions generate many different answers. At least four critical questions can be identified, which are intimately intertwined-(1) What constitutes tool use? (2) What psychological processes underlie tool use in humans and nonhuman animals? (3) Which of these psychological processes are exclusive to tool use? (4) Which psychological processes involved in tool use are exclusive to Homo sapiens? To help advance a multidisciplinary scientific understanding of tool use, six author groups representing different academic disciplines (e.g., anthropology, psychology, neuroscience) and different theoretical perspectives respond to each of these questions, and then point to the direction of future work on tool use. We find that while there are marked differences among the responses of the respective author groups to each question, there is a surprising degree of agreement about many essential concepts and questions. We believe that this interdisciplinary and intertheoretical discussion will foster a more comprehensive understanding of tool use than any one of these perspectives (or any one of these author groups) would (or could) on their own.

OBJECTIVE: When evaluating methods for machine-learning controlled prosthetic hands, able-bodied participants are often recruited, for practical reasons, instead of participants with upper limb absence (ULA). However, able-bodied participants have been shown to often perform myoelectric control tasks better than participants with ULA. It has been suggested that this performance difference can be reduced by restricting the wrist and hand movements of able-bodied participants. However, the effect of such restrictions on the consistency and separability of the electromyogram's (EMG) features remains unknown. The present work investigates whether the EMG separability and consistency between unaffected and affected arms differ and whether they change after restricting the unaffected limb in persons with ULA.METHODS: Both arms of participants with unilateral ULA were compared in two conditions: with the unaffected hand and wrist restricted or not. Furthermore, it was tested if the effect of arm and restriction is influenced by arm posture (arm down, arm in front, or arm up).RESULTS: Fourteen participants (two women, age=53.4±4.05) with acquired transradial limb loss were recruited. We found that the unaffected limb generated more separated EMG than the affected limb. Furthermore, restricting the unaffected hand and wrist lowered the separability of the EMG when the arm was held down.CONCLUSION: Limb restriction is a viable method to make the EMG of able-bodied participants more similar to that of participants with ULA.SIGNIFICANCE: Future research that evaluates methods for machine learning controlled hands in able-bodied participants should restrict the participants' hand and wrist.

Objective: To support the design of assistive devices and prostheses, we investigated the changes in upper-limb muscle synergies during the practice of a myoelectric controlled game using proportional-sequential control. Methods: We evaluated 1) whether individual muscle synergies change in their structure; 2) variability; 3) distinctiveness; and 4) whether individuals become more similar with practice. Ten individuals practiced a myoelectric-controlled serious game for ten consecutive days (25 min/day) and one day after one week without training (retention). Results: The results showed that individuals decreased the number of synergies employed and modified their flexor synergies structure, becoming more similar as a group with practice. Nevertheless, within-individual synergies’ variability and distinctiveness did not change. Conclusion: These results point out that individuals do not demonstrate muscle patterns less variable or differentiable after practice. However, participants increased performance and became more attuned to the task dynamics. Significance: The present findings indicate that, depending on the task requirements, individuals converge to more similar muscle activation patterns – a feature that should be further explored in prosthetic design. ispartof: Biomedical Signal Processing And Control vol:70 status: published

Study Design: Reliability study.Introduction: Quantifying compensatory movements during work-related tasks may help to prevent musculoskeletal complaints in individuals with upper limb absence.Purpose of the Study: (1) To develop a qualitative scoring system for rating compensatory shoulder and trunk movements in upper limb prosthesis wearers during the performance of functional capacity evaluation tests adjusted for use by 1-handed individuals (functional capacity evaluation-one handed [FCE-OH]); (2) to examine the interrater and intrarater reliability of the scoring system; and (3) to assess its feasibility.Methods: Movement patterns of 12 videotaped upper limb prosthesis wearers and 20 controls were analyzed. Compensatory movements were defined for each FCE-OH test, and a scoring system was developed, pilot tested, and adjusted. During reliability testing, 18 raters (12 FCE experts and 6 physiotherapists/gait analysts) scored videotapes of upper limb prosthesis wearers performing 4 FCE-OH tests 2 times (2 weeks apart). Agreement was expressed in % and kappa value. Feasibility (focus area's "acceptability", "demand," and "implementation") was determined by using a questionnaire.Results: After 2 rounds of pilot testing and adjusting, reliability of a third version was tested. The interrater reliability for the first and second rating sessions were kappa = 0.54 (confidence interval [CI]: 0.520.57) and kappa = 0.64 (CI: 0.61-0.66), respectively. The intrarater reliability was kappa = 0.77 (CI: 0.72-0.82). The feasibility was good but could be improved by a training program.Discussion: It seems possible to identify compensatory movements in upper limb prosthesis wearers during the performance of FCE-OH tests reliably by observation using the developed observational scoring system.Conclusions: Interrater reliability was satisfactory in most instances; intrarater reliability was good. Feasibility was established. (C) 2018 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.

PurposeWe examined the possibility that old adults use flexibility in joint coordination as a compensatory mechanism for the age-related decline in muscle strength when performing the sit-to-stand (STS) task repeatedly under high force and balance demands.MethodYoung (n=14, 22.42.1) and old (n=12, 703.2) healthy adults performed repeated STSs under high and low force and balance demands. The balance demand was manipulated by reducing the base of support and the force demand by increasing body weight with a weight vest. Uncontrolled manifold analysis was used to quantify age differences in motor flexibility.Results p id= Par3 While there were age-typical differences in kinematic STS strategies, flexibility in joint coordination was independent of age and task difficulty during repeated STSs.Discussion p id=Par4That simple manipulations of force and balance demands did not affect flexibility in joint coordination in old and young adults suggests that motor flexibility acts as a compensatory mechanism only at the limits of available muscle strength and balance abilities during STS movements. Intervention studies should identify how changes in specific neuromuscular functions affect flexibility in joint coordination during activities of daily living such as STS.

Background Upper limb prosthetics with multiple degrees of freedom (DoFs) are still mostly operated through the clinical standard Direct Control scheme. Machine learning control, on the other hand, allows controlling multiple DoFs although it requires separable and consistent electromyogram (EMG) patterns. Whereas user training can improve EMG pattern quality, conventional training methods might limit user potential. Training with serious games might lead to higher quality EMG patterns and better functional outcomes. In this explorative study we compare outcomes of serious game training with conventional training, and machine learning control with the users’ own one DoF prosthesis. Methods Participants with upper limb absence participated in 7 training sessions where they learned to control a 3 DoF prosthesis with two grips which was fitted. Participants received either game training or conventional training. Conventional training was based on coaching, as described in the literature. Game-based training was conducted using two games that trained EMG pattern separability and functional use. Both groups also trained functional use with the prosthesis donned. The prosthesis system was controlled using a neural network regressor. Outcome measures were EMG metrics, number of DoFs used, the spherical subset of the Southampton Hand Assessment Procedure and the Clothespin Relocation Test. Results Eight participants were recruited and four completed the study. Training did not lead to consistent improvements in EMG pattern quality or functional use, but some participants improved in some metrics. No differences were observed between the groups. Participants achieved consistently better results using their own prosthesis than the machine-learning controlled prosthesis used in this study. Conclusion Our explorative study showed in a small group of participants that serious game training seems to achieve similar results as conventional training. No consistent improvements were found in either group in terms of EMG metrics or functional use, which might be due to insufficient training. This study highlights the need for more research in user training for machine learning controlled prosthetics. In addition, this study contributes with more data comparing machine learning controlled prosthetics with Direct Controlled prosthetics.

Background Current myoelectric prostheses are multi-articulated and offer multiple modes. Switching between modes is often done through pre-defined myosignals, so-called triggers, of which the training hardly is studied. We evaluated if switching skills trained without using a prosthesis transfer to actual prosthesis use and whether the available feedback during training influences this transfer. Furthermore we examined which clinically relevant performance measures and which myosignal features were adapted during training. Methods Two experimental groups and one control group participated in a five day pre-test—post-test design study. Both experimental groups used their myosignals to perform a task. One group performed a serious game without seeing their myosignals, the second group was presented their myosignal on a screen. The control group played the serious game using the touchpad of the laptop. Each training session lasted 15 min. The pre- and post-test were identical for all groups and consisted of performing a task with an actual prosthesis, where switches had to be produced to change grip mode to relocate clothespins. Both clinically relevant performance measures and myosignal features were analysed. Results 10 participants trained using the serious game, 10 participants trained with the visual myosignal and 8 the control task. All participants were unimpaired. Both experimental groups showed significant transfer of skill from training to prosthesis use, the control group did not. The degree of transfer did not differ between the two training groups. Clinically relevant measure ‘accuracy’ and feature of the myosignals ‘variation in phasing’ changed during training. Conclusions Training switching skills appeared to be successful. The skills trained in the game transferred to performance in a functional task. Learning switching skills is independent of the type of feedback used during training. Outcome measures hardly changed during training and further research is needed to explain this. It should be noted that five training sessions did not result in a level of performance needed for actual prosthesis use. Trial registration The study was approved by the local ethics committee (ECB 2014.02.28_1) and was included in the Dutch trial registry (NTR5876).

Pattern-Recognition (PR) control of upper-limb prosthetics has shown inconsistent results outside lab settings, which might be due to the inadequacy of users’ electromyogram (EMG) patterns. To improve the separability and consistency of their EMG, users can receive training. Conventional training uses an internal focus of attention as prosthesis users focus on the muscle contractions of their (phantom) hand together with explicit learning processes facilitated by a coach guiding the user. In this study we investigated if an alternative training paradigm using an external focus of attention exploiting implicit learning processes based on serious gaming without a coach could lead to more separable and consistent EMG. Able-bodied participants (N = 25; mean age 22 years, 13 females) were recruited and followed conventional or game training for five days. In conventional training, participants performed the Motion Test thrice daily and received coaching on how to adapt their muscle contractions. In game training, participants controlled an avatar using a direct mapping from electrode to avatar direction. The participants utilized implicit learning processes, by exploring which muscle contractions made the avatar go in which directions. Performance in both groups was evaluated by using the Motion Test in a pre/post-test design. Training resulted in improved performance, with no differences between training paradigms. Participants who followed game training showed 51% more separated EMG patterns. EMG pattern consistency did not change over training. It was concluded that serious game training using an external focus of attention and implicit learning can be considered as a viable alternative to conventional training.

Goal-directed reaching adapts to meet changing task requirements after unexpected perturbations such as a sudden switch of target location. Literature on adaptive behavior using a target switch has primarily focused on adjustments of the end-effector trajectory, addressing proposed feedback and feedforward processes in planning adjusted actions. Starting from a dynamical systems approach to motor coordination, the current paper focusses on coordination of joint angles after a target switch, which has received little attention in the literature. We argue that joint angles are coordinated in synergies, temporary task-specific units emerging from interactions amongst task, organism, and environmental constraints. We asked whether after a target switch: i) joint angles were coordinated in synergies, ii) joint angles were coordinated in a different synergy than the synergy used when moving to the original target, and iii) synergies or end-effector trajectory was adjusted first. Participants (N = 12) performed manual reaching movements toward a target on a table (stationary target trials), where in some trials the target could unexpectedly switch to a new location (switch trials). Results showed that the end-effector curved to the switched target. Joint angles were synergistically organized as shown by the large extent of co-variation based on Uncontrolled Manifold analyses. At the end of the target switch movement, joint angle configurations differed from the joint angle configurations used to move to the original stationary target. Hence, we argue, a new synergy emerged after the target switch. The order of adjustment in the synergies and in the end-effector was flexible within participants, though most often synergies were adjusted first. These findings support the two-step framework of Kay (1988) to understand the coordination of abundant degrees of freedom and to explain adaptive actions. The flexibility in the order of adjustments of synergies suggests that the coordination of DOF emerges from self-organization.

Purpose To assess repeatability and safety of the functional capacity evaluation-one-handed (FCE-OH), a FCE-OH individuals, consisting of eight items. Method The FCE-OH protocol was administered twice to 23 individuals with upper limb absence (87% male; median age 46 years; median 2 days between sessions). To examine repeatability, test-retest reliability and agreement were assessed with the intraclass correlations coefficient (ICC) and limits of agreement (LoA), respectively. Reliability was considered acceptable when ICC-values were >= 0.75. Widths of LoA of four tests were compared with those of healthy adults. Safety and pain response were assessed with a questionnaire. Results After controlling for stability of construct, ICC-values ranged between 0.23 and 0.96, and widths of LoA ranged between 16 and 79%. Intertrial (learning) effects were present in three test items. No serious adverse reactions were reported. A pain response was reported by 30% of the participants. Conclusion Good or excellent reliability was observed in five tests, while three items showed poor or moderate test-retest reliability. Interpretation of agreement was possible for four tests, of which three showed widths of LoA similar to those reported in healthy adults. Learning effects were present; therefore, interpretation at the individual level should be performed with care. As the CI of several items were wide, confirmation of results in a larger sample is warranted. Safety was confirmed.

High motor variability is an often-found characteristic of Developmental Coordination Disorder (DCD). Still, the role of high motor variability in DCD needs further examination. This study focused on variability in coordination patterns, which is essential considering that DCD is a coordination disorder. We examined variability in coordination patterns of the arm over repetitions of trials in goal-directed reaching movements. This variability was partitioned into variability that does not affect the index fingertip position (V-ucm) and variability that does affect the index fingertip position (V-ort). This study aimed to increase the understanding of motor variability in DCD by comparing V-ucm and V-ort on between children with DCD and typically developing (TD) children in a goal-directed reaching task. Twenty-two children (eleven with DCD) ages 6-11 performed 30 reaching movements. The Uncontrolled Manifold method was used to quantify V-ucm and V-ort. Results showed that children with DCD had more V-ucm than TD children while V-ort was similar between groups, showing that coordination patterns in children with DCD are more variable, but interestingly, this higher variability does not affect performance. This study indicates that high motor variability in DCD is not necessarily negative. Possible roles of motor variability in DCD are discussed.

During rhythmic pointing movements, degrees of freedom (DOF) in the human action system—such as joint-angles in the arm—are assumed to covary to stabilise end-effector movement, e.g. index finger. In this paper, it is suggested that the end-effector movement and the coordination of DOF are reciprocally related in synergies that link DOF so as to produce the end-effector movement. The coordination of DOF in synergies and the relation between end-effector movement and DOF coordination received little attention, though essential to understand the principles of synergy formation. Therefore, the current study assessed how the end-effector movement related to the coordination of joint-angles during rhythmic pointing across target widths and distances. Results demonstrated that joint-angles were linked in different synergies when end-effector movements differed across conditions. Furthermore, in every condition, three joint-angles (shoulder plane of elevation, shoulder inward-outward rotation, elbow flexion-extension) largely drove the end-effector, and all joint-angles contributed to covariation that stabilised the end-effector. Together, results demonstrated synergies that produced the end-effector movement, constrained joint-angles so that they covaried to stabilise the end-effector, and differed when end-effector movement differed. Hence, end-effector and joint-angles were reciprocally related in synergies—indicating that the action system was organised as a complex dynamical system.

Goal-directed actions become truly functional and skilled when they are consistent yet flexible. In manual pointing, end-effector consistency is characterized by the end position of the index fingertip, whereas flexibility in movement execution is captured by the use of abundant arm-joint configurations not affecting the index finger end position. Because adults have been shown to exploit their system's flexibility in challenging conditions, we wondered whether during middle childhood children are already able to exploit motor flexibility when demanded by the situation. We had children aged 5-10 years and adults perform pointing movements in a nonchallenging and challenging condition. Results showed that end-effector errors and flexibility in movement execution decreased with age. Importantly, only the 9-10-year-olds and adults showed increased flexibility in the challenging condition. Thus, while consistency increases and flexibility decreases during mid-childhood development, from the age of nine children appear able to employ more flexibility with increasing task demands.

Purpose Our ability to flexibly coordinate the available degrees of freedom allows us to perform activities of daily living under various task constraints. Healthy old adults exhibit subclinical peripheral and central nervous system dysfunctions, possibly compromising the flexibility in inter-joint coordination during voluntary movements and the ability to adapt to varying task constraints.Method We examined how healthy old (75.4 +/- 5.2 years, n = 14) compared with young adults (24.3 +/- 2 years, n = 15) make use of the available motor flexibility to adapt to physical and dexterity constraints during a rapid goal-directed reaching task. We manipulated physical and dexterity demands by changing, respectively, external resistance and target size. Motor flexibility was quantified by an uncontrolled manifold (UCM) analysis.Results We found that healthy young and old adults employ similar motor flexibility as quantified by the ratio between goal equivalent and non-goal equivalent variability (V-Ratio) and were similarly able to adapt to increases in physical and dexterity demands during goal-directed rapid reaching (V-Ratio: p = .092; young: 0.548 +/- 0.113; old: 0.264 +/- 0.117). Age affected end-effector kinematics. Motor flexibility and end-effector kinematics did not correlate.Conclusions The data challenge the prevailing view that old age affects movement capabilities in general and provide specific evidence that healthy old adults preserve motor flexibility during a reaching task. Future studies applying UCM analysis should examine if experimental set-ups limit movement exploration, leaving possible age differences undetected.

Purpose To develop and pilot test a functional capacity evaluation (FCE) for individuals with upper limb absence (ULA) due to reduction deficiency or amputation, and to examine the relationship between FCE results and presence of musculoskeletal complaints (MSC). Method Five tests (overhead lifting, overhead working, repetitive reaching, fingertip dexterity, and handgrip strength) were selected and adapted if necessary. The newly developed FCE, called FCE-One-Handed (FCE-OH), was pilot tested in 20 adults individuals with ULA, and 20 matched controls. MSC were assessed via a questionnaire. Results Adaptations were considered necessary for all tests, except the handgrip strength test. The repetitive overhead lifting test of the non-affected limb was added. On the overhead lifting test, individuals with above-elbow ULA (ten males), performed similar to controls using one hand. When lifting bimanually using the prosthesis, a trend for lower lifting capacity of individuals with below-elbow ULA (seven males, three females) was observed compared to controls. On the overhead working test, individuals with above-elbow ULA performed worse compared to controls. Other tests showed no significant differences between groups. Relationships between FCE results and presence of MSC were non-significant. Conclusion The FCE-OH can be used to test functional capacity of one-handed individuals. Individuals with ULA generally showed similar functional capacity as two-handed individuals. FCE results were not related to MSC. It was discussed that a higher physical load on the non-affected limb might reflect a relative deficit of functional capacity.

Study Design: Cross-sectional.Introduction: Southampton Hand Assessment Procedure (SHAP) provides function scores for hand grips (prehensile patterns) and an overall score, the index of function (IOF). The underlying equations of SHAP are not publicly available, which induces opacity. Furthermore, SHAP has been scarcely tested in prosthetic users.Methods: Issues with SHAP-IOF are discussed: an alternative scoring system, that is, linear index of function (LW) and a weighted version (W-LIF) are presented. In LIF, task times are transformed linearly, relative to SHAP norms, and are computed into LIF-prehensile patterns (LIFpp). LIF and IOF were compared using data of 27 experienced prosthetic users.Results: High correlation and agreement between LIF and IOF was found: LIFpp vs IOFpp ranged from r = 0.880 to r = 0.988, and W-LIF vs 10F had a correlation coefficient of r = 0.984.Discussion: SHAP data of prosthetic users are valuable benchmarks for health care professionals. LIF calculations are a good and cost free alternative for 10F scores.Conclusion(s): Measurements with LIF and 10F may be considered similar, but LIF is transparent and easier to use than 10F. Level of Evidence: Clinical measurement and cross-sectional. (C) 2016 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.

To allow different views on motor learning to inform rehabilitation research, the authors aimed to explicate a frequently missed yet fundamental difference in starting point of such views. By considering how rehabilitation in practice answers the question of what parts an activity consists of, reductive and emergent approaches to motor learning are identified and traced throughout rehabilitation practice. The authors show that when a task is cut up along reductive dimensions while also apparently relying on emergent components, this unequally favors the reductive approach and acts to limit the views on motor learning available. By showing the approaches in practice, the authors hope to inspire an awareness that brings both approaches the opportunity to independently inform research so that new theories and practices can proliferate.

Human-machine interfaces have not yet advanced to enable intuitive control of multiple degrees of freedom as offered by modern myoelectric prosthetic hands. Pattern Recognition (PR) control has been proposed to make human-machine interfaces in myoelectric prosthetic hands more intuitive, but it requires the user to generate high-quality, i.e., consistent and separable, electromyogram (EMG) patterns. To generate such patterns, user training is required and has shown promising results. However, how different levels of feedback affect effectivity in training differently, has not been established yet. Furthermore, a correlation between qualities of the EMG patterns (the focus of training) and user performance has not been shown yet. In this study, 37 able-bodied participants (mean age 21 years, 19 males) were recruited and trained PR control over five days. Three levels of feedback were tested for their effectiveness: no external feedback, visual feedback and visual feedback with coaching. Training resulted in improved performance from pre-to post-test with no interaction effect of feedback. Feedback did however affect the quality of the EMG patterns where people who did not receive external feedback generated higher amplitude patterns. A weak correlation was found between a principal component, composed of EMG amplitude and pattern variability, and performance. Our results show that training is highly effective in improving PR control regardless of feedback and that none of the quality metrics correlate with performance. We discuss how different levels of feedback can be leveraged to improve PR control training.

ObjectiveTo describe users' and therapists' opinions on multi-function myoelectric upper limb prostheses with conventional control and pattern recognition control.DesignQualitative interview study.SettingsTwo rehabilitation institutions in the Netherlands and one in Austria.SubjectsThe study cohort consisted of 15 prosthesis users (13 males, mean age: 43.7 years, average experience with multi-function prosthesis: 3.15 years) and seven therapists (one male, mean age: 44.1 years, average experience with multi-function prostheses: 6.6 years). Four of these users and one therapist had experience with pattern recognition control.MethodThis study consisted of semi-structured interviews. The participants were interviewed at their rehabilitation centres or at home by telephone. The thematic framework approach was used for analysis.ResultsThe themes emerging from prosthesis users and therapists were largely congruent and resulted in one thematic framework with three main themes: control, prosthesis, and activities. The participants mostly addressed (dis-) satisfaction with the control type and the prosthesis itself and described the way they used their prostheses in daily tasks.ConclusionProsthesis users and therapists described multi-function upper limb prostheses as more functional devices than conventional one-degree-of-freedom prostheses. Nonetheless, the prostheses were seldom used to actively grasp and manipulate objects. Moreover, the participants clearly expressed their dissatisfaction with the mechanical robustness of the devices and with the process of switching prosthesis function under conventional control. Pattern recognition was appreciated as an intuitive control that facilitated fast switching between prosthesis functions, but was reported to be too unreliable for daily use and require extensive training.

Studies on myocontrolled assistive technology (AT), such as myoelectric prostheses, as well as rehabilitation practice using myoelectric controlled interfaces, commonly assume the existence of a general myocontrol skill. This is the skill to control myosignals in such a way that they are employable in multiple tasks. If this skill exists, training any myocontrolled task using a certain set of muscles would improve the use of myocontrolled AT when the AT is controlled using these muscles. We examined whether a general myocontrol skill exists in myocontrolled tasks with and without a prosthesis. Unimpaired, right-handed adults used the sEMG of wrist flexors and extensors to perform several tasks in two experiments. In Experiment 1, twelve participants trained a myoelectric prosthesis-simulator task and a myocontrolled serious game for five consecutive days. Performance was compared between tasks and over the course of the training period. In Experiment 2, thirty-one participants performed five myocontrolled tasks consisting of two serious games, two prosthesis-simulator tasks and one digital signal matching task. All tasks were based on tasks currently used in clinical practice or research settings. Kendall rank correlation coefficients were computed to analyze correlations between the performance on different tasks. In Experiment 1 performance on the tasks showed no correlation for multiple outcome measures. Rankings within tasks did not change over the training period. In Experiment 2 performance did not correlate between any of the tasks. Since performance between different tasks did not correlate, results suggest that a general myocontrol skill does not exist and that each myocontrolled task requires a specific skill. Generalization of those findings to amputees using AT should be done with caution since in both experiments unimpaired participants were included. Moreover, training duration in Experiment 2 was short. Our findings indicate that training and assessment methods for myocontrolled AT use should focus on tasks frequently performed in daily life by the individual using the AT instead of merely focusing on training myosignals.

Objective Operating a multi-articulating myoelectric prosthetic hand requires both proportional control of surface electromyography (sEMG) signals and accurately producing triggers to switch between grip types. Proportional control, used for hand opening/closing, has been studied extensively but the grip-switching control far less so. Can switching be trained and if so, how early on can improvement be seen? And is the ability to produce precise switches related to proficiency in proportional control? We examined individual learning differences, monitored improvements in switching control, and assessed whether skilful proportional control predicts proficient switching. Methods Twenty-three unimpaired participants fitted with sEMG electrodes on the wrist flexors/extensors performed two 10-minute tasks: an adaptive virtual catching task (proportional control) and an sEMG- feedback-based switching task, with multiple performance measures being recorded and compared. Results Most outcome measures revealed large individual differences, with 47–87% of the participants showing improvement in switching and 14% deteriorating. As hypothesized, no correlations were found between mode-switching and proportional-control skills. Conclusion Learning to generate accurate grip-switching control proved difficult and might not be feasible for all individuals with upper-limb amputations. Unaffected participants showing proficient proportional control were not automatically good at producing well-tuned mode switches. Significance In rehabilitation, clients with good proportional control are often offered a multi-articulating hand prosthesis. Since we found no clear associations between the proficiency in proportional movements and mode switches, this rationale may warrant reconsideration. Rather, when selecting the most optimal prosthesis, an individual’s skills in both control types should be examined separately.

The effect that a motor skill trained on one side can lead to improvement in the untrained side is called intermanual transfer. Intermanual transfer can help enhance upper limb prosthetic training. To determine the influence of mirror therapy and motor imagery on intermanual transfer in upper limb prosthesis training, a pseudo-randomized clinical trial, single blinded, with a pre-posttest design was used. Forty-seven able-bodied, right-handed participants were pseudo-randomly assigned to two training groups and one control group. One training group undertook an intermanual transfer training program, using an upper-limb prosthetic simulator with added mirror therapy and motor imagery. The second training group completed only the intermanual transfer training program. The control group completed a sham training: a dummy training without using the prosthesis simulator. The program lasted five consecutive days. To determine the improvement in skill, a test was administered before, immediately after, and six days after the training program. Training used the "unaffected" arm; tests were performed with the "affected" arm, resembling the amputated limb. Movement time, the time from the beginning of the movement until completion of the task; hand opening, the duration of the maximum prosthetic hand opening; and grip-force control, the deviation from the required force during a tracking task. No intermanual transfer effects were found: neither the intermanual transfer training program, nor the additional mirror therapy and motor imagery affected prosthesis skills. A limitation of the study was that the training program was applied to able-bodied subjects instead of patients with an amputation. Contrary to previous studies, no intermanual transfer effects were found. Additional mirror therapy and motor imagery did not ameliorate intermanual transfer effects.

To compare the prevalence of musculoskeletal complaints (MSCs) in individuals with finger or partial hand amputations (FPHAs) with a control group and to explore the effect and predictors of MSCs in individuals with FPHAs.A questionnaire-based cross-sectional study was conducted. The primary outcome measures were: prevalence of MSCs, health status, pain-related disability, physical work demands, work productivity, and hand function.The response rate was 61%. A comparable proportion of individuals with FPHAs (n = 99) and controls (n = 102) reported MSCs in the preceding 4 weeks (33% vs. 28%, respectively) or in the preceding year (37% vs. 33%, respectively). Individuals with FPHAs with MSCs experienced more pain than controls with MSCs. Regular occurrence of stump sensations and self-reported limited range of motion (ROM) of the wrist of the affected limb were predictors for MSCs in individuals with FPHAs.The prevalence of MSCs was comparable in individuals with FPHAs and controls. However, clinicians should pay special attention to the risk of developing MSCs in patients with stump sensations and limited ROM of the wrist of the affected limb. Future research should focus on the role of wrist movements and compensatory movements in the development of MSCs in individuals with FPHAs. Implications for Rehabilitation The prevalence of musculoskeletal complaints (MSCs) in individuals with finger or partial hand amputations (FPHAs) and control subjects was similar. Regular occurrence of stump sensations and limited range of motion of the wrist of the affected limb were predictors of developing MSCs in individuals with FPHAs. Clinicians should pay special attention to individuals with FPHAs with the presence of these predictors of developing MSCs. For a better understanding of the development of and treatment options for MSCs, future research focusing on the role of wrist function in the development of MSCs in individuals with FPHAs is necessary.

Inspired by the Developmental Systems perspective, we studied the development of reaching during mid-childhood (5-10 years of age) not just at the performance level (i.e., endpoint movements), as commonly done in earlier studies, but also at the joint angle level. Because the endpoint position (i.e., the tip of the index finger) at the reaching target can be achieved with multiple joint angle combinations, we partitioned variability in joint angles over trials into variability that does not (goal-equivalent variability, GEV) and that does (non-goal-equivalent variability, NGEV) influence the endpoint position, using the Uncontrolled Manifold method. Quantifying this structure in joint angle variability allowed us to examine whether and how spatial variability of the endpoint at the reaching target is related to variability in joint angles and how this changes over development. 6-, 8- and 10-year-old children and young adults performed reaching movements to a target with the index finger. Polynomial trend analysis revealed a linear and a quadratic decreasing trend for the variable error. Linear decreasing and cubic trends were found for joint angle standard deviations at movement end. GEV and NGEV decreased gradually with age, but interestingly, the decrease of GEV was steeper than the decrease of NGEV, showing that the different parts of the joint angle variability changed differently over age. We interpreted these changes in the structure of variability as indicating changes over age in exploration for synergies (a family of task solutions), a concept that links the performance level with the joint angle level. Our results suggest changes in the search for synergies during mid-childhood development.

Gebruikers van een armprothese moeten compensatiebewegingen maken om dagelijkse taken en werkgerelateerde taken uit te kunnen voeren met hun prothese. Deze compensatiebewegingen kunnen spier- en gewrichtsklachten veroorzaken of in stand houden. Gebruikers van een armprothese maken de meeste compensatiebewegingen met beide schouders en de romp. Doelen van dit onderzoek waren (1 het ontwikkelen van een observationeel scoresysteem voor het scoren van compensatiebewegingen bij armprothesegebruikers tijdens de uitvoering van testen van de functional capacity evaluation aangepast voor prothesegebruikers en eenhandigen (FCE-OH), en (2 het bepalen van de inter- en intrabeoordelaarsbetrouwbaarheid van het scoresysteem.