Monitoring of Upper Limb Prosthesis Activity in Trans-Radial Amputees

  • Mohammad Sobuh
  • Laurence Kenney
  • Phil Tresadern
  • Martin Twiste
  • Sibylle Thies


There has been a shift in rehabilitation medicine from conventional evaluation procedures towards more quantitative approaches. However, up to now, a quantitative evaluation procedure for upper limb prostheses that is applicable outside of the laboratory or clinical environment has not been established. The requirement for such a procedure arises from the findings of a number of recent studies suggesting that unilateral trans-radial amputees do not involve their prosthesis in task performance in real life situations, even if they are able to demonstrate the use of the prosthesis in the clinical environment. This suggests that laboratory, or clinic-based assessments are limited in the information they provide to clinicians or designers of new prostheses. Further, self-report approaches, such as questionnaires or interviews rely on accurate recall and reporting by subjects, an approach that has been shown to be flawed in other rehabilitation and public health domains.

Therefore, this chapter reports a study investigating the feasibility of quantifying the nature and duration of tasks performed with a myoelectric prosthesis by means of an activity monitor. It was hypothesised that by monitoring the prosthesis hand opening and closing it may be possible to identify the manipulation phase. Such information could be used to segment acceleration signals, measured from arm-located accelerometers, which may contain information characterising the task(s) being performed and differentiate it/them from other tasks. The results of this study indicate that, by using a neural network classifier, customised for each user, acceleration signals measured during the manipulation phase of task performance could accurately characterise the task being performed. The implications of these findings and future work are discussed here.


Classification Accuracy Activity Monitoring Acceleration Data Hand Opening Residual Limb 



The authors gratefully acknowledge the financial support from the University of Jordan and thank the participants in the study. The authors also acknowledge colleagues at the University of Strathclyde for their assistance with figures 4.2– 4.4.


  1. Agnew PJ (1981) Functional effectiveness of a myo-electric prosthesis compared with a functional split-hook prosthesis: a single subject experiment. Prosthet Orthot Int 5:2–96Google Scholar
  2. Bagley AM, Molitor F, Wagner LV et al (2006) The unilateral below elbow test: a function test for children with unilateral congenital below elbow deficiency. Dev Med Child Neurol 48:569–575PubMedCrossRefGoogle Scholar
  3. Bergman K, Ornholmer L, Zackrisson K et al (1992) Functional benefit of an adaptive myoelectric prosthetic hand compared to a conventional myoelectric hand. Prosthet Orthot Int 16:32–37PubMedGoogle Scholar
  4. Bernmark E, Wiktorin C (2002) A triaxial accelerometer for measuring arm movements. Appl Ergon 33:541–547PubMedCrossRefGoogle Scholar
  5. Bishop CM (2005) Neural networks for pattern recognition. Oxford university press, Oxford, UKGoogle Scholar
  6. Black N, Biden EN, Rickards J (2005) Using potential energy to measure work related activities for persons wearing upper limb prostheses. Robotica 23:319–327CrossRefGoogle Scholar
  7. Buffart LM, Roebroeck ME, Pesch-Batenburg JM et al (2006) Assessment of arm/hand functioning in children with a congenital transverse or longitudinal reduction deficiency of the upper limb. Disabil Rehabil 28:85–95PubMedCrossRefGoogle Scholar
  8. Burger H, Marincek C (1994) Upper limb prosthetic use in Slovenia. Prosthet Orthot Int 18:25–33PubMedGoogle Scholar
  9. Burger H, Brezovar D, Marincek C (2004) Comparison of clinical test and questionnaires for the evaluation of upper limb prosthetic use in children. Disabil Rehabil 26:911–916PubMedCrossRefGoogle Scholar
  10. Busse ME, Pearson OR, Van Deursen R et al (2004) Quantified measurement of activity provides insight into motor function and recovery in neurological disease. J Neurol Neurosurg Psychiatry 75:884–888PubMedCrossRefGoogle Scholar
  11. Bussmann HB, Reuvekamp PJ, Veltink PH et al (1998) Validity and reliability of measurements obtained with an “activity monitor” in people with and without a transtibial amputation. Phys Ther 78:989–998PubMedGoogle Scholar
  12. Cappozzo A, Catani F, Croce UD, et al (1995) Position and orientation in space of bones during movement: anatomical frame definition and determination. Clin Biomech (Bristol, Avon) 10:171–178Google Scholar
  13. Cappozzo A, Catani F, Leardini A et al (1996) Position and orientation in space of bones during movement: experimental artefacts. Clin Biomech (Bristol, Avon) 11:90–100Google Scholar
  14. Chau T (2001a) A review of analytical techniques for gait data. Part 2: neural network and wavelet methods. Gait Posture 13:102–120PubMedCrossRefGoogle Scholar
  15. Chau T (2001b) A review of analytical techniques for gait data. Part 1: fuzzy, statistical and fractal methods. Gait Posture 13:49–66PubMedCrossRefGoogle Scholar
  16. Coleman KL, Smith DG, Boone DA et al (1999) Step activity monitor: long-term, continuous recording of ambulatory function. J Rehabil Res Dev 36:8–18PubMedGoogle Scholar
  17. Culhane KM, O’Connor M, Lyons D et al (2005) Accelerometers in rehabilitation medicine for older adults. Age Ageing 34:556–560PubMedCrossRefGoogle Scholar
  18. Edelstein JE, Berger N (1993) Performance comparison among children fitted with myoelectric and body-powered hands. Arch Phys Med Rehabil 74:376–380PubMedGoogle Scholar
  19. Fordyce W (1976) Behavioral methods for chronic pain and illness. Mosby, St. Louis, MOGoogle Scholar
  20. Fraser CM (1998) An evaluation of the use made of cosmetic and functional prostheses by unilateral upper limb amputees. Prosthet Orthot Int 22:216–223PubMedGoogle Scholar
  21. Gaine WJ, Smart C, Bransby-Zachary M (1997) Upper limb traumatic amputees. Review of prosthetic use. J Hand Surg [Br] 22:73–76Google Scholar
  22. Gambrell CR (2008) Overuse syndrome and the unilateral upper limb amputee: consequences and prevention. J Prosthet Orthot 20:126CrossRefGoogle Scholar
  23. Godfrey A, Conway R, Meagher D et al (2008) Direct measurement of human movement by accelerometry. Med Eng Phys 30:1364–1386PubMedCrossRefGoogle Scholar
  24. Grant PM, Ryan CG, Tigbe WW et al (2006) The validation of a novel activity monitor in the measurement of posture and motion during everyday activities. Br J Sports Med 40:992–997PubMedCrossRefGoogle Scholar
  25. Haeuber E, Shaughnessy M, Forrester LW et al (2004) Accelerometer monitoring of home- and community-based ambulatory activity after stroke. Arch Phys Med Rehabil 85:1997–2001PubMedCrossRefGoogle Scholar
  26. Hansson G, Asterland P, Holmer N et al (2001) Validity and reliability of triaxial accelerometers for inclinometry in posture analysis. Med Biol Eng Comput 39:405–413PubMedCrossRefGoogle Scholar
  27. Hansson GA, Arvidsson I, Ohlsson K et al (2006) Precision of measurements of physical workload during standardised manual handling. Part II: Inclinometry of head, upper back, neck and upper arms. J Electromyogr Kinesiol 16:125–136Google Scholar
  28. Hermansson LM, Fisher AG, Bernspang B et al (2005) Assessment of capacity for myoelectric control: a new Rasch-built measure of prosthetic hand control. J Rehabil Med 37:166–171PubMedGoogle Scholar
  29. Hermansson LM, Bodin L, Eliasson AC (2006) Intra- and inter-rater reliability of the assessment of capacity for myoelectric control. J Rehabil Med 38:118–123PubMedCrossRefGoogle Scholar
  30. Jahanshahi M, Philips C (1986) Validating a new technique for the assessment of pain behaviour. Behav Res Ther 24:35–42PubMedCrossRefGoogle Scholar
  31. Jones LE, Davidson JH (1999) Save that arm: a study of problems in the remaining arm of unilateral upper limb amputees. Prosthet Orthot Int 23:55–58PubMedGoogle Scholar
  32. Kejlaa GH (1993) Consumer concerns and the functional value of prostheses to upper limb amputees. Prosthet Orthot Int 17:157–163PubMedGoogle Scholar
  33. Light CM, Chappell PH, Kyberd PJ et al (1999) A critical review of functionality assessment of natural and prosthetic hands. Br J Occup Ther 62:7–12Google Scholar
  34. Light CM, Chappell PH, Kyberd PJ (2002) Establishing a standardized clinical assessment tool of pathologic and prosthetic hand function: Normative data, reliability, and validity. Arch Phys Med Rehabil 83:776–783PubMedCrossRefGoogle Scholar
  35. Malone JM, Fleming LL, Roberson J et al (1984) Immediate, early, and late postsurgical management of upper-limb amputation. J Rehabil Res Dev 21:33–41PubMedGoogle Scholar
  36. Mathie MJ, Coster ACF, Lovell NH et al (2004) Accelerometry: providing an integrated, practical method for long-term, ambulatory monitoring of human movement. Physiol Meas 25:R1–R20PubMedCrossRefGoogle Scholar
  37. Meier RH, Atkins DJ (2004) Functional restoration of adults and children with upper extremity amputation. Demos, New YorkGoogle Scholar
  38. Millstein SG, Heger H, Hunter GA (1986) Prosthetic use in adult upper limb amputees: a comparison of the body powered and electrically powered prostheses. Prosthet Orthot Int 10:27–34PubMedGoogle Scholar
  39. Muzumdar A (2004) Powered upper limb prostheses: control, implementation and clinical application. Springer, BerlinGoogle Scholar
  40. NASDAB (2005) The amputee statistical database for the United Kingdom [annual report] (2005/06) Information Services Division, NHS Scotland. Edinburgh. Accessed 28 Dec 2008
  41. Northmore-Ball MD, Heger H, Hunter GA (1980) The below-elbow myo-electric prosthesis. A comparison of the Otto Bock myo-electric prosthesis with the hook and functional hand. J Bone Joint Surg Br 62:363–367PubMedGoogle Scholar
  42. Pezzin LE, Dillingham TR, Mackenzie EJ et al (2004) Use and satisfaction with prosthetic limb devices and related services. Arch Phys Med Rehabil 85:723–729PubMedCrossRefGoogle Scholar
  43. Preece SJ, Goulermas JY, Kenney LP, Howard D, Meijer K, Crompton R. (2009) Activity identification using body-mounted sensors – A review of classification techniques. Physiol Meas. 30(4):R1–33Google Scholar
  44. Pruitt SD, Varni JW, Setoguchi Y (1996) Functional status in children with limb deficiency: development and initial validation of an outcome measure. Arch Phys Med Rehabil 77:1233–1238PubMedCrossRefGoogle Scholar
  45. Pruitt SD, Varni JW, Seid M et al (1998) Functional status in limb deficiency: development of an outcome measure for preschool children. Arch Phys Med Rehabil 79:405–411PubMedCrossRefGoogle Scholar
  46. Pruitt SD, Seid M, Varni JW et al (1999) Toddlers with limb deficiency: conceptual basis and initial application of a functional status outcome measure. Arch Phys Med Rehabil 80:819–824PubMedCrossRefGoogle Scholar
  47. Ren L, Jones R, Howard D (2005) A software package for three-dimensional motion analysis of general biomechanical multi-body systems. In: Proceedings of biomechanics of the lower limb in health, disease and rehabilitation, University of Salford, UK, 122–123Google Scholar
  48. Resnick B, Nahm ES, Orwig D et al (2001) Measurement of activity in older adults: reliability and validity of the step activity monitor. J Nurs Meas 9:275–290PubMedGoogle Scholar
  49. Roeschlein RA, Domholdt E (1989) Factors related to successful upper extremity prosthetic use. Prosthet Orthot Int 13:14–18PubMedGoogle Scholar
  50. Schasfoort FC, Bussmann JB, Zandbergen AM et al (2003) Impact of upper limb complex regional pain syndrome type 1 on everyday life measured with a novel upper limb-activity monitor. Pain 101:79–88PubMedCrossRefGoogle Scholar
  51. Schasfoort FC, Bussmann JB, Krijnen HJ et al (2006) Upper limb activity over time in complex regional pain syndrome type 1 as objectively measured with an upper limb-activity monitor: an explorative multiple case study. Eur J Pain 10:31–39PubMedCrossRefGoogle Scholar
  52. Silcox DH, Rooks MD, Vogel RR et al (1993) Myoelectric prostheses. A long-term follow-up and a study of the use of alternate prostheses. J Bone Joint Surg Am 75:1781–1789PubMedGoogle Scholar
  53. Smith DG, Michael JW, Bowker JH (2004) Atlas of amputations and limb deficiencies: Surgical, prosthetic, and rehabilitation principles. American Academy of Orthopaedic Surgeons, Rosemont, ILGoogle Scholar
  54. Sobuh M (2008) Monitoring of upper limb prosthesis activity in trans-radial amputees – A feasibility study. MSc thesis Institute for Health & Social Care Research (IHSCR), School of Health Care Professions. University of Salford, Salford, UKGoogle Scholar
  55. Tresadern PA, Thies SB, Kenney LP, Howard D, Smith C, Rigby J, Goulermas JY (2009) Simulating acceleration from stereophotogrammetry for medical device design. J Biomech Eng 131(6):061002Google Scholar
  56. Thies SB, Tresadern P, Kenney L et al (2007) Comparison of linear accelerations from three measurement systems during “reach & grasp”. Med Eng Phys 29:967–972PubMedCrossRefGoogle Scholar
  57. Thornby MA, Krebs DE (1992) Bimanual skill development in pediatric below-elbow amputation: a multicenter, cross-sectional study. Arch Phys Med Rehabil 73:697–702PubMedGoogle Scholar
  58. Tulen JH, Bussmann HB, van Steenis HG et al (1997) A novel tool to quantify physical activities: ambulatory accelerometry in psychopharmacology. J Clin Psychopharmacol 17:202–207PubMedCrossRefGoogle Scholar
  59. Turk DC, Wack JT, Kerns RD (1985) An empirical examination of the “pain-behavior” construct. J Behav Med 8:119–130PubMedCrossRefGoogle Scholar
  60. UNB test of prosthetics function: A test for unilateral upper extremity amputees, ages 2-13 [test manual] (1985) Bio-Engineering Institute, University of Brunswick. Fredericton, New Brunswick. Accessed 14 May 2008
  61. Uswatte G, Miltner WH, Foo B et al (2000) Objective measurement of functional upper-extremity movement using accelerometer recordings transformed with a threshold filter. Stroke 31:662–667PubMedGoogle Scholar
  62. Uswatte G, Foo WL, Olmstead H et al (2005) Ambulatory monitoring of arm movement using accelerometry: an objective measure of upper-extremity rehabilitation in persons with chronic stroke. Arch Phys Med Rehabil 86:1498–1501PubMedCrossRefGoogle Scholar
  63. van Lunteren A, van Lunteren-Gerritsen GH, Stassen HG, et al (1983) A field evaluation of arm prostheses for unilateral amputees. Prosthet Orthot Int 7:141–151Google Scholar
  64. Vega-Gonzalez A, Granat MH (2005) Continuous monitoring of upper-limb activity in a free-living environment. Arch Phys Med Rehabil 86:541–548PubMedCrossRefGoogle Scholar
  65. Vlaeyen JW, Van Eek H, Groenman NH et al (1987) Dimensions and components of observed chronic pain behavior. Pain 31:65–75PubMedCrossRefGoogle Scholar
  66. Weaver SA, Lange LR, Vogts VM (1988) Comparison of myoelectric and conventional prostheses for adolescent amputees. Am J Occup Ther 42:87–91PubMedGoogle Scholar
  67. Welk GJ, Blair SN, Wood K et al (2000) A comparative evaluation of three accelerometry-based physical activity monitors. Med Sci Sports Exerc 32:S489–S497PubMedCrossRefGoogle Scholar
  68. Wright VF (2006) Measurement of functional outcome with individuals who use upper extremity prosthetic devices: Current and future directions. J Prosth Orthot 18:46–56Google Scholar
  69. Wright TW, Hagen AD, Wood MB (1995) Prosthetic usage in major upper extremity amputations. J Hand Surg [Am] 20:619–622Google Scholar
  70. Wright FV, Hubbard S, Naumann S et al (2003) Evaluation of the validity of the prosthetic upper extremity functional index for children. Arch Phys Med Rehabil 84:518–527PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Mohammad Sobuh
  • Laurence Kenney
    • 1
  • Phil Tresadern
  • Martin Twiste
  • Sibylle Thies
  1. 1.Centre for Rehabilitation and Human Performance Research, Brian Blatchford buildingUniversity of SalfordSalfordUK

Personalised recommendations