Maintaining stable transfemoral amputee gait on level,sloped and simulated uneven conditions in a virtual environment

Purpose: Describe and quantify how people with transfemoral amputations (TFA) maintain stable gait over a variety of surfaces; including, downhill and uphill, top and bottom-cross-slopes, medial-lateral translations, rolling hills and simulated rocky surfaces.

Methods: Ten TFA and ten matched people without amputations (NA) walked in a virtual environment with level, sloped and simulated uneven surfaces on a self-paced treadmill. Stability was quantified using medial-lateral margin of stability (ML-MoS), step parameters, and gait variability (standard deviations for speed, temporal-spatial parameters, foot clearance and root-mean-square of medial-lateral trunk acceleration).

Results and conclusions: TFA and NA adapted to non-level conditions by changing their walking speed, step width, and foot clearance. Variability for most parameters increased across conditions, compared to level. TFA walked slower than NA with shorter, wider and longer duration steps (most differences related to speed). ML-MoS did not change compared to level; however, ML-MoS was greater on the prosthetic side than both intact side and NA limbs. Foot clearance and root-mean-square of medial-lateral trunk acceleration were greater on the prosthetic side than the intact side and NA limbs. This research provides a comprehensive analysis of the different adaptations made by people without amputations compared to people with transfemoral amputations over non-level conditions and establishes significant differences between slopes and simulated uneven surfaces for TFA.

• Implications for Rehabilitation

• Transfemoral amputation and no amputation groups adapted walking biomechanics when traversing non-level surfaces.

• Greatest temporal-spatial gait adaptations were walking speed, step width and foot clearance.

• Gait parameter variability typically increased from the level condition in both groups.

• Transfemoral amputation group walked slower than no amputation group with shorter, wider steps and longer duration steps. This was related to speed.

• Transfemoral amputation group had more trunk motion variability on the prosthetic side than no amputation group; could be related to prosthetic fit.

     

Comparison of carbon fibre and aluminium materials in the construction of ultralight wheelchairs

Abstract

Carbon fibre-reinforced polymers have been used in the sporting goods industry for decades, and wheelchairs have incorporated the material since the late 1980s. There is no independently collected data available on carbon fibre-reinforced polymer wheelchairs’ performance on the ANSI/RESNA testing standards, however. This study evaluated three full carbon fibre wheelchair specimens to determine their performance versus similar wheelchairs. Testing determined that while the frames survived more testing cycles than any other wheelchair, the casters and rear tires failed similarly to other devices. Overall, due to the purchase cost, the cost benefit of the tested wheelchair model was similar to aluminium wheelchairs.

• Implications for rehabilitation

• Carbon fibre wheelchair construction is a viable alternative to aluminium, titanium, or steel construction, and decreasing costs will continue to improve the benefits of carbon fibre over these models

• Carbon fibre wheelchair found to be more durable than aluminium models, but are also much more expensive. The additional cost may be justified for some users that need the increased durability, however

• Increased durability will reduce the number of repairs and warranty claims, potentially reducing the burden on a wheelchair user, and also improving their ability to travel and participate in their community

• The low weight of carbon fibre wheelchairs may increase the mobility of some users by allowing them to transfer more easily into and out of vehicles and manoeuvre throughout the environment

     

A condensed wheelchair skills training ‘bootcamp’ improves students’ self-efficacy for assessing,training, spotting,and documenting manual and power wheelchair skills

Abstract

Objectives: To determine the influence of a bootcamp training approach on students’ self-efficacy for assessing, training, spotting, documenting, and performing manual and power wheelchair skills.

Methods: In a pre-post design, students in their final year of an entry-to-practice master of occupational therapy program completed a two-day manual (6.5?h) and power (6.5?h) wheelchair skills bootcamp. Outcomes for self-efficacy (in assessing, training, spotting and documenting manual and power wheelchair skills; primary) and capacity (manual and power wheelchair skills; secondary) were collected at baseline and immediately after the bootcamp.

Results: Participants (n?=?44) were 27.3?±?4.3?years of age (41 female). Most students (81.8%) reported little previous experience using manual and power wheelchairs at baseline. Students’ self-efficacy for assessing, training, spotting, and documenting manual and power wheelchair skills improved by between 28.4% and 35.3%, representing a change from ‘somewhat confident’ to ‘fairly confident’. Students’ manual and power wheelchair skills capacity increased by 47.2% and 37.1% respectively.

Conclusions: Wheelchair skills training bootcamps may help prepare occupational therapy students to assess, train, spot, and document manual and power wheelchair skills of future clients, while improving students’ wheelchair skills capacity; thus may provide an option for integrating wheelchair skills training into the curriculum of time-intensive programs.

• Implications for rehabiliation

• A two-day condensed wheelchair skills training workshop improves occupational therapy

• students’ self-efficacy for assessing, training, spotting and documenting power and

• manual wheelchair skills.

• A two-day condensed wheelchair skills training workshop improves occupational

• therapy students’ power and manual wheelchair skills.

• Self-efficacy is an indicator of future behaviours. Therefore, improving students’ selfefficacy

• for assessing training and documenting wheelchair skills may influence their future practice.

     

Translation and cross-cultural adaptation of the Wheelchair Skills Test (WST) version 4.3 form from English to Colombian Spanish

Abstract

Introduction: The World Health Organization estimates that in 2010, 15% of the world’s population lived with some form of disability and 10% of these people required wheelchairs. Colombia and other Spanish-speaking countries lack reliable scales, and ones that are in Spanish, to assess wheelchair handling skills such as that provided by the Wheelchair Skills Test 4.3.

Objective: To translate and cross-culturally adapt the Wheelchair Skills Test 4.3 form to Spanish, to be used with the Colombian population that uses a wheelchair.

Materials and method: The design of this research uses a methodology that centres on validation studies and transcultural adaptation following the stages of translation, back translation and evaluation of translations by the author and expert judgement.

Results: The adaptation had a global agreement index of 93.3 (Total Agreement Level). The three indicators were 92% relevance, 93.3% coherence and 94.5% sufficiency; and 22 of the 51 items evaluated (43.1%) had a 100% agreement level.

Conclusions: The outcome of this transcultural adaptation was the Colombian Spanish version of the Wheelchair Skills Test (WST) 4.3 Form.

• Implications for rehabilitation

• Fifteen per cent of the world’s population (2010), and 10% of people with disabilities need wheelchairs.

• The Colombian population requiring the use of a manual wheelchair, 51% are limited in terms of “walking, running, jumping” and permanently limited in their movement for walk (29.32%).

• The use of reliable and cross-culturally adapted scales, such as the Wheelchair Wheelchair Skills Test (WST), is essential for rehabilitation personnel.

• The assessment of wheelchair user skills is fundamental to identify the level of participation in their respective communities as well as the development of their basic activities.

     

An exploration of the experiences of Brazilian hemiplegic manual wheelchair users

Abstract

Purpose: The objective of this research was to explore the experiences of 11 hemiplegic users with their manual wheelchairs.

Method: The phenomenological approach explored the subjective experiences of Brazilian hemiplegic manual wheelchair users in order to identify and describe the factors that affected their relationship with their wheelchair. Using in depth semistructured interviews. The data were analysed using thematic analysis. The health records from the physiotherapy service of the Health Department of Itajaí were reviewed to identify hemiplegic wheelchair users.

Results: The results identified 4?key themes: heteronomy, inadequate/inappropriateness of wheelchair design, poor state of the pavements and roads prohibiting wheelchair use and lack of suitable wheelchair provision.

Conclusion: The findings confirm that current manual wheelchair provision, both new and secondhand, for this group of users is inadequate and they highlighted the issues and problems arising from the current provision. A novel finding was the identification of heteronomy that resulted from the provision of unsuitable equipment.

• Implication for rehabilitation

• Adding into physiotherapy and occupational therapy education, the importance of matching technology to the user in their environment.

• The importance of involving the user in decisions made about wheelchair provision.

• Sharing findings with wheelchair manufacturers to improve manual wheelchair design for hemiplegic users.

     

Psychosocial and physical adjustments and prosthesis satisfaction in amputees: a systematic review of observational studies

Abstract

Background: Adjustment to amputation is a complex process because it encompasses physical and psychosocial aspects as well as satisfaction with the artificial limb.

Purpose: To review the scientific production on psychosocial and physical adjustments to amputation and prosthesis use as well as prosthetic satisfaction in people with lower limb amputation in the last 10?years.

Methods: This review was conducted on the MEDLINE via Pubmed, Web of Science and Scopus databases. Original and observational studies published in the last 10?years were included, with topics related to adjustment to amputation and prosthesis use as well as prosthetic satisfaction in people with lower limb amputations.

Results: A total of 1042 articles were identified in the initial search, but after analysing the criteria 16 articles were used for analysis in their entirety. Regarding psychosocial adjustments, higher rates of depression, anxiety and body image disorders were observed among people with amputations. Phantom and residual limb pain, gender, employment status and daily hours of prosthesis use may influence psychosocial adjustment. Physical adjustment may be influenced by the level of amputation, educational background, age, daily prosthesis use, ambulatory assistive devices and presence of comorbidities. The areas of greatest prosthetic dissatisfaction were colour and weight.

Conclusion: Considering that most of the studies related to the satisfaction and adjustment of the prosthesis are cross-sectional studies, longitudinal studies should be conducted, since monitoring individuals over the years and verifying how these variables change over time may contribute to obtaining more data on the factors that influence prosthetic fitting and satisfaction.

• Implications for rehabilitation

• Adjustment to amputation and prosthesis use involves both physical and psychosocial issues, it is important that besides physical rehabilitation, psychological interventions and education and communication activities between the patient and the health professionals are carried out.

• The adaptation to the prosthesis and the recovery of walking capacity are important goals in the rehabilitation process and the knowledge of the physical and psychosocial factors associated with amputation and the use of the prosthesis can help the health team to provide better care to these subjects.

• Well-adjusted, comfortable and easy-to-use prostheses are of great importance as they enable the patient to perform their daily activities and maintain their independence.

• It is important to encourage the participation of the individual in both rehabilitation and choice of prosthesis.

     

Transtibial amputee gait with the unity suspension system

Abstract

Study Design: Experimental study.

Objectives: Research is lacking on the Unity suspension system’s effect on gait performance. The purpose of this study was to evaluate the effects of the Unity elevated vacuum system on level walking performance while the vacuum was active (ON) and inactive (OFF).

Methods: Twelve unilateral transtibial amputees were fit with the Ossur elevated vacuum suspension system (Unity) and Pro-flex XC foot. After one month accommodation period, 3D motion analysis was performed using the CAREN-Extended system. Temporal-spatial, kinematics, and kinetics were examined during level walking to understand the effect of the elevated vacuum, separate trials were completed with the vacuum active (ON) or inactive (OFF).

Results: Significant differences were found between vacuum conditions (ON and OFF) for some temporal-spatial gait parameters, but differences were very small and may not be clinically significant. Differences between vacuum conditions on most kinetic and kinematic gait parameters were also low. However, step length symmetry between intact and prosthetic limbs improved with active elevated vacuum (ON).

Conclusions: Elevated vacuum suspension’s effect on level walking gait is small if a well-fitting liner-based socket is provided.

• Implications for rehabilitation

• Step length symmetry between intact and prosthetic limbs improved with an active vacuum system.

• Differences between vacuum conditions on most gait parameters were small during level walking.

• Subjective feedback showed improved proprioception and comfort with an active vacuum system.

     

Prosthetic use in elderly patients with dysvascular above-knee and through-knee amputations

Fifty-five patients with vascular insufficiency resulting in above-knee (AK) and through-knee (TK) amputations were studied to determine factors related to prosthetic candidacy and functional outcome. Chart review showed that the only difference between patients who were fitted with prostheses and those who were not fitted with prostheses was their respective number of medical complications. Twenty-three of 31 patients with prostheses were evaluated 7 to 35 months after receiving the prostheses. Ten (44%) of these patients wore their prostheses all day every day and used wheelchairs minimally or not at all. Over half of the patients evaluated used their wheelchairs most of the time. Two (9%) of the 23 patients had stopped wearing their prostheses. Patients who demonstrated increased walking distances and velocities at follow-up used their prostheses more and their wheelchairs less than did the other patients. Neither gait factors nor hip range of motion at discharge was predictive of continued prosthetic use. Functional outcome and prosthetic use were limited in this group of elderly patients with dysvascular AK and TK amputations. The results of this study may serve as a basis for clinical determination of prosthetic candidacy and functional goals.     

A survey on what Australians with upper limb difference want in a prosthesis: justification for using soft robotics and additive manufacturing for customized prosthetic hands

Abstract

Purpose: Upper limb prostheses are part of a rapidly changing market place. Despite development in device design, surveys report low levels of uptake and dissatisfaction with current prosthetic design. In this study, we present the results of a survey conducted with people with upper limb difference in Australia on their use of current prostheses and preferences in a prosthetic in order to inform future prosthetic hand design.

Methods: An online survey was conducted on upper limb amputees, with 27 respondents that completed the survey. The survey was a mixture of open-ended questions, ranking design features and quantitative questions on problems experienced and desired attributes of future prosthesis designs.

Results: Common key issues and concerns were isolated in the survey related to the weight, manipulation and dexterity, aesthetics, sensory feedback and financial cost; each of which could be addressed by additive manufacturing and soft robotics techniques.

Conclusions: The adaptability of additive manufacturing and soft robotics to the highlighted concerns of participants shows that further research into these techniques is a feasible method to improve patient satisfaction and acceptance in prosthetic hands.

• Implications for rehabilitation

• Even with recent developments and advances in prosthetic design, the needs and desires of prosthetic users are not being met with current products.

• The desires and needs of those with upper limb difference are diverse.

• Using additive manufacturing to produce prosthetics allows for mass customization of prosthetics to meet these diverse needs while reducing costs.

• A soft robotic approach to prosthetics can help meet the desires of reducing weight and costs, while maintaining functionality.

     

The aerodynamic impact of a range of prostheses designs when cycling with a trans-tibial amputation

Abstract

Previous studies have proposed that an aerodynamically optimized prosthetic limb could provide performance enhancement for competitive paracyclists. Four different designs of prosthetic limbs were assessed for their impact upon the aerodynamic drag of an elite cyclist with a lower-limb amputation. The pylon area acted as the controlled location for the differences in design between the test prostheses. A validated field test method was used to derive the participant’s total aerodynamic drag when using the prostheses designs. The field test method produced a repeatable experimental process and demonstrated that small changes in form made to the pylon region resulted in measurable differences to the participant’s cycling performance. In addition, statistical significance was obtained between a baseline design and the prostheses prototype with the greatest aspect ratio (p=?<.05). The magnitude of improvements recorded in this study could potentially influence a rider’s finishing time at international sporting events like the Paralympic Games.

• Implications for Rehabilitation

• Small changes in form made to a cycling prostheses design can potentially deliver worthwhile performance enhancement.

• Prosthetists may obtain greater end-user satisfaction by taking a broader approach to sports prostheses design than just fit and biomechanical function alone.

• This study indicates that other regions of the cycling prosthesis could now benefit from aerodynamic optimization with the aim to further improve paracycling performance.

     

Development of a scoring tool (BLARt score) to predict functional outcome in lower limb amputees

Purpose: To develop a valid preoperative scoring tool that predicts the probability of walking with a prosthetic limb after major lower limb amputation.

Methods: A retrospective review of 338 patients who had undergone lower limb amputation was conducted to identify characteristics that affected the success of rehabilitation with a prosthetic limb. These data were used to devise an assessment tool (the BLARt score), which was then tested and validated in 199 patients planned to undergo lower limb amputation in two UK regional centers. Functional rehabilitation outcomes were recorded at 12?months after surgery using the SIGAM mobility grading.

Results: No patient with a BLARt score?≥13 achieved good functional outcome (defined as independent mobility, SIGAM grade E or F) and only 6 patients with a BLARt score?≥17 achieved any functional outcome (defined as any ability to walk unaided, SIGAM grade C or greater).

Conclusions: In the patient cohorts studied, the BLARt assessment tool was a strong predictor of whether or not patients would be able to walk with a prosthetic limb after surgery. It is simple to administer and could be useful in clinical practice to inform expectations for patients and clinicians.

• Implications for rehabilitation

• Patients undergoing lower limb amputation face major physical and psychological challenges after surgery that have a considerable impact on rehabilitation and their ability to walk independently.

• Many amputees are unable to walk with a prosthetic limb, but there are no validated tools to predict this before surgery.

• The BLARt is a potentially valuable measure that can predict the likelihood of being unable to walk after amputation.

• It is simple to use and could be useful to inform patients’ and clinicians’ expectations before surgery.

     

The future of the provision process for mobility assistive technology: a survey of providers

Purpose: The purpose of this study was to evaluate the opinions of providers of mobility assistive technologies to help inform a research agenda and set priorities.

Materials and methods: This survey study was anonymous and gathered opinions of individuals who participate in the process to provide wheelchairs and other assistive technologies to clients. Participants were asked to rank the importance of developing various technologies and rank items against each other in terms of order of importance. Participants were also asked to respond to several open-ended questions or statements.

Results: A total of 161 providers from 35 states within the USA consented to participation and completed the survey.

Conclusions: This survey revealed themes of advanced wheelchair design, assistive robotics and intelligent systems, human machine interfaces and smart device applications. It also outlined priorities for researchers to provide continuing education to clients and providers. These themes will be used to develop research and development priorities.

• Implications for Rehabilitation

• ??Research in advanced wheelchair design is needed to facilitate travel and environmental access with wheelchairs and to develop alternative power sources for wheelchairs.??New assistive robotics and intelligent systems are needed to help wheelchairs overcome obstacles or self-adjust, assist wheelchair navigation in the community, assist caregivers and transfers, and aid ambulation.??Innovations in human machine interfaces may help advance the control of mobility devices and robots with the brain, eye movements, facial gesture recognition or other systems.??Development of new smart devices is needed for better control of the environment, monitoring activity and promoting healthy behaviours.

     

An investigation into the relationship between paracycling athletes and their prosthetics technology: a proposed design framework

Abstract

Objective: Product attachment has been stated as an emotional relationship an end-user may develop with a tangible product or artefact. The objective of this study is to investigate this relationship with athletes who possess limb absence and utilise assistive sports technology competitively.

Method: Five elite paracyclists were surveyed using a modified 31 question product attachment survey. The survey comprised the ability to capture both closed-ended and open-ended data. The survey design itself was derived from three previously validated product relationship questionnaires.

Results: Four elite athletes with limb absence did not provide any firm evidence or indication to support the concept of a non-physical relationship with their prosthetic device. However, some respondents had (or wished) to incorporate some form of aesthetic-based prosthetic personalisation or customisation, as long as this did not impact on the prostheses functional performance. Furthermore, a thematic analysis of the participant's responses yielded a four-point assistive technology design philosophy framework. The emerging thematic areas were 1) The identification of the factors that influence performance in the athletes chosen sport; 2) To consider an ‘appearance follows performance’ approach; 3) To conduct sports specific trials of the prosthetic limb; and 4) To identify any need for prostheses decorative personalisation.

Conclusions: The survey revealed some anecdotes of a sports technology to user relationship but this will require further exploration with different and larger sample populations. Use of the proposed four-point framework may help inform practitioners of what considerations could provide greater end-user satisfaction when designing and developing specialised prosthetic limbs for elite-level sport.

• Implications for rehabilitation

• Whilst the formal characteristics of product attachment were not broadly identified in this study, some indications may give credence for prosthetists to consider an “appearance follows performance” approach to sports prostheses design. This may improve end-user satisfaction with their assistive technology.

• The inclusion of prosthetic post-manufacture decoration and personalization would seem to be desirable to the end-user.

• By adopting the feedback given in this study, undertaking trials conducted at a race-specific intensity of the athlete end-user may reduce the need to perform post-manufacture ad-hoc prostheses modifications.

     

Comfort and stability of wheelchair backrests according to the TAWC (tool for assessing wheelchair discomfort)

Purpose: The goal of this study was thus to determine if people with different types of wheelchair backrests on their personal wheelchairs reported different levels of comfort as measured by the Tool for Assessing Wheelchair disComfort (TAWC). Methods: Participants were between 18 and 80 years of age and were manual wheelchair users. The TAWC was used to assess the participants’ wheelchair seating discomfort levels with the wheelchair and seating systems. Results: We surveyed 131 wheelchair users to assess the comfort of their backrests on their personal wheelchairs and found a trend suggesting that rigid backrests are were less comfortable as compared with sling backrests. This finding was statistically significant in a subgroup of participants with tetraplegia. Conclusions: Although many clinicians expect rigid backrests to be more comfortable because they may provide more support, the higher discomfort ratings among rigid backrest users with tetraplegia may be due to sub-optimal shape, fit, adjustment or user preferences.

• Implications for Rehabilitation

• Development of a measure for long-term seating discomfort is needed.

• Design and development of better rigid backrests that are functional but provide adequate comfort are in need.

     

The influence of operator and wheelchair factors on wheelchair propulsion effort

Abstract

Purpose: The goal of this study was to evaluate the relative influence of operator and wheelchair factors on propulsion effort during over-ground wheelchair manoeuvres.

Method: This observational study included 23 full-time manual wheelchair users and 13 able-bodied subjects. The operator factors included shoulder position, aerobic capacity and propulsion strength. The wheelchair factors included system mass, weight distribution, and frictional loss in straight and turning trajectories. The performance of over-ground manoeuvres was defined as the propulsion effort measured by VO₂ as operators propelled along a modified figure-8 course on tile and carpet surfaces.

Results: According to our regression model, shoulder position was the only significant contributor within operator factors, whereas weight distribution was the only significant contributor within wheelchair factors in influencing propulsion efforts. When combining operator and mechanical factors in the regression model, weight distribution became the only significant contributor to influence propulsion effort.

Conclusion: Weight distribution and shoulder position had a significant influence on propulsion effort. These variables are related to the operator’s relationship to the drive wheels. However, system mass and muscle strength had the least influence on wheelchair manoeuvres. Our finding can help clinicians to improve wheelchair configurations and manufacturers to improve wheelchair design by understanding the importance of shoulder position and weight distribution.

• Implication for rehabilitation

• Studying wheelchair manoeuvers by considering both wheelchair and operator factors might provide a unique insight to address the complex interactions among wheelchair designs and users.

• Propulsion effort decreases as percentage weight is increased on the drive wheels and the shoulder becomes more aligned with the axle position, which highlights the need to optimize wheelchair axle position.

• Wheelchair configuration, as represented by weight distribution, had a more significant influence on everyday manoeuvre than wheelchair mass does.

• It is essential for wheelchair users to choose a wheelchair that can match their daily needs and anthropometric measurements for saving propulsion efforts.

     

Living with limb loss: everyday experiences of “good” and “bad” days in people with lower limb amputation

Purpose: To provide an understanding of the everyday experiences of individuals with a limb amputation.

Methods: Twenty-two participants (14 female, 8 male) with a mean-age of 42 years (SD?=?10?years) were recruited to take part in two focus groups. The participants reported a range of lower-limb amputations (i.e., congenital, acquired, transfemoral, trantibial, unilateral, and bilateral) and on an average were 5 years post-surgery (SD?=?7 years). Each focus group comprised of 11 participants and was moderated by either the first or second author. The moderator asked participants to discuss their everyday experiences of life with an amputation using Charmaz’s good day/bad day approach. Focus groups were transcribed verbatim and analyzed using an inductive thematic analysis.

Results: Four themes were identified: pain, organization and planning, the embodied experience after amputation, and interactions with others.

Conclusions: These themes provide a key resource for understanding daily fluctuations in physical, social, and psychological functioning.

• Implications for Rehabilitation

• Lower limb amputation can result in daily fluctuations in physical, social, and psychological functioning.

• These fluctuations can be illustrated through experiences of pain, planning and organization, embodied experiences, and interactions with others.

• At a policy level, evaluations of daily living after an amputation should be based on a longitudinal assessment.

     

Adjustment to finger amputation and silicone finger prosthesis use

Purpose: Finger amputations are the most common amputations of upper limbs. They influence hand function, general functioning and quality of life. One of the possibilities for rehabilitation after finger amputation is fitting a silicone finger prosthesis. We wanted to evaluate the adjustment to amputation and prosthesis use in patients after finger amputation.

Methods: We included 42 patients with partial or complete single or multiple finger amputation of one hand who visited the outpatient clinic for prosthetics and orthotics at our institute and received a silicone prosthesis. We assessed their adjustment to amputation and prosthesis with the Trinity Amputation and Prosthesis Experience Scales (TAPES).

Results: Most of the patients (28, 67%) had a single finger amputated. The average scores on all TAPES subscales (except adjustment to limitation) were above 50% of the maximum possible score. On average, the scores were the highest on the general adjustment and satisfaction with the prosthesis subscales.

Conclusions: Silicone prostheses for finger amputation of upper limb play an important role in the process of adaptation to amputation. They offer aesthetically satisfying results and alleviate social interactions, which influences overall quality of life.

• Implications for Rehabilitation

• Silicone prostheses for finger amputation of upper limb offer an aesthetically satisfying result and alleviate problems with social interactions.

• Their influence on hand function is not optimal, but the prosthesis improves the amputee's quality of life.