Objective: The objective of the current investigation was twofold: i) described a remote fitting procedure for upper limb 3D printed prostheses and ii) assess patient satisfaction and comfort with 3D printed prostheses fitted remotely.Design: A qualitative study using content and score analysis to describe patient satisfaction after 4 weeks of using an upper limb 3D printed prosthesis fitted remotely. The novel remote fitting procedure is described in detail.Subjects: Six children (three girls and three boys, 6 to 16 years of age) and 2 adults (males of 25 and 59 years of age) with congenital (n=7) and acquired (n=1) upper limb loss participated in this study. Results:The research participants reported a score of 3.92 ± 0.50 (closer to the statement "quite satisfied") for the device satisfaction section of the QUEST questionnaire (Table 2). This acceptable level of satisfaction of our research participant reported in the QUEST was confirmed by the agreement scores of the OPUS items related to prosthetic fitting (My prosthesis fits well = 4.13 ± 0.50) and comfort (My prosthesis is comfortable throughout the day = 3.57 ± 0.98).Furthermore, the comfort level rating in the general prosthetic survey resulted in a score of 3.75 ± 0.70 (closer to the statement "the prosthetic device feels comfortable") confirming the results of the QUEST and OPUS. Conclusions:The ability to fit an upper-limb prosthesis remotely, represents a promising methodology to fit upper-limb 3D printed prostheses for patients from developing countries or rural areas. The increasing availability of smartphones and other digital devices makes it possible to obtain photographs from patients located in rural areas that have little or no access to trained technicians. These photographs along with the cost-effective desktop 3D printers allows for the 3 extraction of the anthropometric measurements required for the development of a 3D printed upper limb prosthesis remotely.

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BackgroundCo-contraction is the simultaneous activation of agonist and antagonist muscles that produces forces around a joint. It is unknown if the use of a wrist-driven 3D printed transitional prostheses has any influence on the neuromuscular motor control strategies of the affected hand of children with unilateral upper-limb reduction deficiencies. Thus, the purpose of the current investigation was to examine the coactivation index (CI) of children with congenital upper-limb reduction deficiencies before and after 6 months of using a wrist-driven 3D printed partial hand prosthesis.MethodsElectromyographic activity of wrist flexors and extensors (flexor carpi ulnaris and extensor digitorum) was recorded during maximal voluntary contraction of the affected and non-affected wrists. Co-contraction was calculated using the coactivation index and was expressed as percent activation of antagonist over agonist. Nine children (two girls and seven boys, 6 to 16 years of age) with congenital upper-limb deficiencies participated in this study and were fitted with a wrist-driven 3D printed prosthetic hand. From the nine children, five (two girls and three boys, 7 to 10 years of age) completed a second visit after using the wrist-driven 3D printed partial hand prosthesis for 6 months.ResultsSeparate two-way repeated measures ANOVAs were performed to analyze the coactivation index and strength data. There was a significant main effect for hand with the affected hand resulting in a higher coactivation index for flexion and extension than the non-affected hand. For wrist flexion there was a significant main effect for time indicating that the affected and non-affected hand had a significantly lower coactivation index after a period of 6 months.ConclusionThe use of a wrist-driven 3D printed hand prosthesis lowered the coactivation index by 70% in children with congenital upper limb reduction deficiencies. This reduction in coactivation and possible improvement in motor control strategies can potentially improve prosthetic rehabilitation outcomes.

Background The purpose of the current study was to determine the influence of upper-limb prostheses on brain activity and gross dexterity in children with congenital unilateral upper-limb reduction deficiencies (ULD) compared to typically developing children (TD). Methods Five children with ULD (3 boys, 2 girls, 8.76 ± 3.37 years of age) and five age- and sex-matched TD children (3 boys, 2 girls, 8.96 ± 3.23 years of age) performed a gross manual dexterity task (Box and Block Test) while measuring brain activity (functional near-infrared spectroscopy; fNIRS). Results There were no significant differences (p = 0.948) in gross dexterity performance between the ULD group with prosthesis (7.23 ± 3.37 blocks per minute) and TD group with the prosthetic simulator (7.63 ± 5.61 blocks per minute). However, there was a significant (p = 0.001) difference in Laterality Index (LI) between the ULD group with prosthesis (LI = − 0.2888 ± 0.0205) and TD group with simulator (LI = 0.0504 ± 0.0296) showing in a significant ipsilateral control for the ULD group. Thus, the major finding of the present investigation was that children with ULD, unlike the control group, showed significant activation in the ipsilateral motor cortex on the non-preferred side using a prosthesis during a gross manual dexterity task. Conclusions This ipsilateral response may be a compensation strategy in which the existing cortical representations of the non-affected (preferred) side are been used by the affected (non-preferred) side to operate the prosthesis. This study is the first to report altered lateralization in children with ULD while using a prosthesis. Trial registration The clinical trial (ClinicalTrial.gov ID: NCT04110730 and unique protocol ID: IRB # 614-16-FB) was registered on October 1, 2019 (https://clinicaltrials.gov/ct2/show/NCT04110730) and posted on October 1, 2019. The study start date was January 10, 2020. The first participant was enrolled on January 14, 2020, and the trial is scheduled to be completed by August 23, 2023. The trial was updated January 18, 2020 and is currently recruiting