Survey of Upper-Extremity Prosthesis Users in Sweden

and the United Kingdom

Peter J. Kyberd, PhD, Constanze Wartenberg, PhD, Leif Sandsjö, PhD, Stewe Jönsson, CPO, David Gow, BSc,
Joakim Frid, MSc, Christian Almström, PhD, Lena Sperling, PhD

ABSTRACT
A sample of 156 users of upper-limb prostheses from three fitting centers in Sweden and the United Kingdom participated
in a survey that focused on user satisfaction. The survey was conducted via postal questionnaire. It included questions to
record demographic data and prostheses type and usage. Respondents were asked to assess their level of satisfaction with
their prostheses and were invited to comment on potential improvements to their current devices. The sample was
heterogeneous with respect to the type of limb loss, principle type of prosthesis, and subject gender and age. Ratings of
comfort, cosmetics, function, and maintenance revealed a high level of satisfaction with the current generation of
prostheses. Separate analysis of responses from users of cosmetic and electric prostheses showed that both groups are
concerned about the prostheses’ appearance. Users of electric prostheses particularly expressed a desire for improved
functionality. Respondents requested lighter, more reliable and more anthropomorphic devices, quiet operation, wide
range of grip shapes, and intuitive control. (J Prosthet Orthot. 2007;19:55–62.)
KEY INDEXING TERMS: artificial arms, control, design, myoelectric control, prosthetic limbs, survey

E
ssential to all aspects of the supply of equipment and Prosthetic Arm with high Workability, DE420) aimed to im-
services is the monitoring of the end users’ satisfac- prove the design and application of upper-limb prostheses.1
tion. This is especially true for health care, whether it This project builds on the experience and technology of three
is partly or wholly publicly funded. The survey reported here of the leading research programs in Western Europe con-
is part of a larger program funded by the European Union ducted during the last 30 years.2–5
(EU) aimed at improving the quality of life and provision for
the elderly (Technology for the Integration of the Disabled
and Elderly, TIDE). Specifically, ToMPAW (Totally Modular
BACKGROUND
PETER J. KYBERD, PhD, is affiliated with the Institute of Biomedical
Engineering, University of New Brunswick, Fredericton, Canada. Affil- THE TOMPAW PROJECT
iation at time of the study was Oxford Orthopaedic Engineering Center, Developed in Sweden during the 1970s, the SVEN hand
NOC, Oxford, United Kingdom.
project aimed to produce a hand and wrist system controlled
CONSTANZE WARTENBERG, PhD, is affiliated with the National by a pattern recognition system that used the operators’
Institute for Working Life, Göteborg, Sweden. impressions of their phantom limbs to drive the device. This
LEIF SANDSJÖ, PhD, is affiliated with the National Institute for led to the clinical use of the hand in Sweden.2,6
Working Life and also with Product and Production Development, The Edinburgh arm contributed to the development of
Chalmers University of Technology, Göteborg, Sweden. the concept of extended physiological proprioception to
STEWE JÖNSSON, CPO, is a Prosthetist at Sahlgrenska University control the arm in a manner with more appropriate feed-
Hospital, Göteborg, Sweden. back than any other system. Later work by Gow et al.3 led to
DAVID GOW, BSc, is Director of Rehabilitation Engineering Ser- the world’s first practical powered-shoulder system, which is
vices, Lothian Health, Edinburgh, Scotland. Affiliation at time of the currently the only one used in the field by leading research
study was the Bioengineering Unit, Princess Margaret Rose Hospital, groups.7,8
Edinburgh, Scotland. The Southampton Hand embodied the concept of hierar-
JOAKIM FRID, MSc, is affiliated with the National Institute for chical control, where the controller uses the information
Working Life, Göteborg, Sweden. from sensors within and outside the hand to decide on the
CHRISTIAN ALMSTRÖM, PhD, is affiliated with Lindholmen Devel- most appropriate grip shape and force to maintain a stable
opment, Göteborg, Sweden. grasp on a particular object.4,5,9,10 Versions of the hand have
LENA SPERLING, PhD, is affiliated with the Department of Design been used in the field for years, and the idea of hierarchical
Sciences, Faculty of Engineering, Lund University, Lund, Sweden. control—where the prosthesis responds to the environment
Copyright © 2007 American Academy of Orthotists and Prosthetists. of the device and the actions of the users—is now being
Correspondence to: Peter J. Kyberd, PhD, Institute of Biomedical adopted in upper- and lower-limb prostheses.
Engineering, University of New Brunswick, 25 Dineen Drive, PO Box Specifically, this survey adds to the knowledge obtained
4400, Fredericton, NB E3B 5A3 New Brunswick, Canada; e-mail: during an earlier EU-funded project, the details of which are
pkyberd@unb.ca reported by Kyberd and colleagues.5,11

Volume 19 • Number 2 • 2007 55

Kyberd et al. JPO Journal of Prosthetics and Orthotics

SURVEY ● Older than 16 years of age

The survey was used in the process of creating the speci- ● Attendee of one of the limb-fitting centers
fication of the ToMPAW device. It could then be used as a The subjects were selected if they fit the criteria and were
point of reference for the progress of the arm development. It considered “active users” by their local centers (i.e., they had
has a more general utility in supplying data concerning the attended the center within the last 3 years11). Questionnaires
interests and concerns of the population in two countries, were sent, the responses were collected, and participants were
adding to and updating previous work and allowing the con- provided with a summary of the results of the study, ensuring
text of different cultural backgrounds to be observed. feedback to the user group (while maintaining anonymity).
The study was designed to include a heterogeneous group of
prosthesis users from three fitting centers in two European
countries (Sweden and Great Britain). With a focus on the users’ RESULTS
viewpoints, the survey used both closed and open questions, Of 156 users contacted, 117 (75%) responded. Some general
enabling participants to name aspects of most concern. Results information about the nonrespondents was available at the fit-
are categorized by the types of prostheses used. The closed ting centers in Göteborg and Edinburgh, showing no particular
questions were from an earlier survey,5 so some comparisons bias in age, gender, or prosthesis type in the nonrespondents.
could be made with the earlier work. Four respondents reported they do not wear their pros-
Although a number of projects collect knowledge about theses and thus were excluded from additional analysis. The
the user population and its wishes, many are restricted to distribution of the remaining 113 participants with respect to
single sites or single countries.11–14 This study included three the level of loss, the principle type of prosthesis used, and
centers in two European countries, which allows for compar- subject gender and age is presented in Table 1.
ison of the different perspectives between the countries.
PROSTHESIS TYPE
Cosmetic prostheses are the most common type of artifi-
METHODS
cial limb reported for all different levels of limb loss. Among
The survey was conducted at three fitting centers (see the respondents, 28% use more than one type of prosthesis.
Appendix). A questionnaire was mailed to the selected partic- The use of different types of prostheses is more common
ipants. If no response was forthcoming within 2 weeks, one among users who wear electric prostheses more frequently
reminder was sent. (40%) than among users whose main prosthesis is a cosmetic
device (20%).
QUESTIONNAIRE
The questionnaire consisted of four sections: USE
1. An introductory letter outlining the background and Most participants (76%) wore their prostheses more than
main purpose of the survey 8 hours daily, with 46% reporting a wear time of more than
2. Ten closed questions concerning the type(s) of prosthe- 12 hours/day. This includes using the prosthesis during work
ses used as well as the type and frequency of usage.5 (73%), sports (60%), and for driving (62%). A rather small
3. Questions pertaining to degree of satisfaction with group of 10 respondents (9%) use their prostheses only
qualities of the prosthesis used most frequently, includ- occasionally and for a shorter duration. Of these occasional
ing comfort, functionality, and daily usage. “Function- users, four had a cosmetic prosthesis and four an electric
ality” here is restricted to manipulative functionality. prosthesis. This is in the upper end of previously reported
Other nonmanipulative aspects of functionality (i.e., ranges (58%–77%).11,15–17
holding and stabilizing objects) that are included in
Fraser’s analysis of actions performed with a prosthe- SATISFACTION/DISSATISFACTION WITH
sis13 are not included. Satisfaction was rated on a 10- PROSTHESES
point scale ranging from “very satisfied” (10) to “very To assess users’ views of their prostheses in detail, satis-
dissatisfied” (1). Respondents were asked to nominate faction was rated using 17 qualities of comfort, functionality,
three improvements they would most like to see. Space and daily use of the prosthesis. Ratings were expressed on a
was provided for inclusion of additional comments. 10-point scale. Results from these questions are shown in
4. Four questions on general demographic and epidemi- Figure 1.
ological information about the participants. To aid comparison of results, each respondent’s individual
rating was standardized relative to the mean and standard
Inclusion criteria:
deviation of all their scores. Thus, a standardized value of 0
● Unilateral upper-extremity loss corresponds to the personal mean rating, and a value of 1
● User of an upper-extremity prosthesis corresponds to one standard deviation above the personal
● No additional impairments relevant for the use of the mean. In this way, each person has the same overall weight in
prosthesis the analysis. These results are shown in Figure 2.

56 Volume 19 • Number 2 • 2007

JPO Journal of Prosthetics and Orthotics Survey of Upper-Extremity Prosthesis Users

Table 1. Distribution of the survey sample regarding type of limb loss, principle type of prosthesis, and subject gender and age*

Göteborg Stockholm Edinburgh All

Users contacted 65 43 48 156
Respondents (% of those contacted) 48 (72%) 32 (67%) 37 (77%) 117 (72%)
Responses included in analysis 47 29 37 113
Level of loss
Shoulder 2 (4%) 1 (3%) 5 (14%) 8 (7%)
Elbow 12 (26%) 15 (52%) 8 (22%) 35 (31%)
Wrist 30 (64%) 11 (38%) 24 (65%) 65 (58%)
Type of prosthesis most used
Cosmetic prostheses 23 (49%) 18 (62%) 27 (73%) 68 (60%)
Electrically powered prostheses 18 (38%) 5 (17%) 7 (19%) 30 (27%)
Other (including mechanical) 6 (13%) 6 (21%) 3 (8%) 15 (13%)
Gender
Male 35 (75%) 17 (59%) 16 (43%) 68 (60%)
Female 10 (21%) 10 (35%) 20 (54%) 40 (35%)
Age (y)
16–20 0 (0%) 0 (0%) 10 (27%) 10 (9%)
21–30 4 (8.5%) 5 (17%) 4 (11%) 13 (12%)
31–40 8 (17%) 8 (28%) 6 (16%) 22 (20%)
41–50 7 (15%) 4 (14%) 4 (11%) 15 (13%)
51–60 15 (32%) 6 (21%) 4 (11%) 25 (22%)
61–70 7 (15%) 5 (17%) 6 (16%) 18 (16%)
70–80 3 (6%) 0 (0%) 1 (3%) 4 (4%)
81⫹ 2 (4%) 0 (0%) 1 (3%) 3 (3%)

*Some categories are missing responses, thus they do not total 100%.

COMPARISON OF USERS OF ELECTRIC AND donning and doffing was a notable consideration for the users
COSMETIC PROSTHESES of shorter prostheses (p ⬍ 0.2).
This report concentrates on a comparison between cosmetic
and electric prostheses because the choice of the hand prosthe- AREAS OF MOST CONCERN
sis user is of primary concern to both users and providers. To provide the users a place for an unstructured response,
Mean ratings of satisfaction/dissatisfaction between the one question was left open: In what way would you like to
two groups did not differ greatly. Taking all qualities into improve your prosthesis? Participants could name as many as
account, the mean overall satisfaction of users of cosmetic three aspects. For comparison, the three most frequently
prostheses is 6.9, whereas the corresponding value for users identified improvements were grouped into the same catego-
of electric prostheses is 6.7. The difference is not statistically ries in the closed questions. The degree of correlation be-
significant. However, the detailed profiles (Figure 2) show tween the open and closed responses was high. There was just
that the groups are concerned about different aspects of their one new area identified in the closed questions: the range of
prostheses. movement of the hand/arm. In addition, one area (donning
and doffing) was closely related to the fit of the socket, so
LEVEL OF ABSENCE
these were combined in the analysis.
If the standardized satisfaction ratings are broken down Table 2 summarizes central improvements participants
further into transhumeral and transradial categories, there named as relevant. The frequency of the identified areas of
are few discernible differences. Not surprisingly, there are few improvement was analyzed as a percentage of the number of
significant differences among the users of cosmetic arms, respondents in the two categories of electric and cosmetic
although the strength of a transradial fitting is seen as pos- prostheses (Figure 3).
itive, and the public perception of the transhumeral device is
more positively felt (t-test, p ⬍ 0.1).
Although there is less general agreement between the RATINGS OF OCCASIONAL USERS
groups of transradial and transhumeral absences in the users Of special interest are ratings of people who used their
of electrically powered arms, there was less variation in any prosthesis only occasionally. The four users of electric pros-
particular category. The ability to generate force in the tran- theses who report only limited use expressed dissatisfaction
shumeral systems was seen as positive (p ⬍ 0.1). Ease of with aspects of functionality. They also showed considerable

Volume 19 • Number 2 • 2007 57

Kyberd et al. JPO Journal of Prosthetics and Orthotics

Figure 1. Rating of the respondents’ satisfaction for 17 qualities using levels of comfort, functionality, and daily use of the prosthesis as a
guide. Ratings were expressed on a 10-point scale, ranging from “very dissatisfied” (1) to “very satisfied” (10). Distribution is mean ⫾
25%.

Figure 2. The areas of improvement identified by the respondents analyzed as a percentage of the number of respondents for electric and
cosmetic prostheses.

58 Volume 19 • Number 2 • 2007

JPO Journal of Prosthetics and Orthotics Survey of Upper-Extremity Prosthesis Users

Table 2. Features identified as the primary areas for improvement DISCUSSION

Category Named Improvement The response rate of 75% is well above the range of typical
values (10%–50%),19 confirming the choices made in the
Weight Electric prostheses should be design of the questionnaire.
lighter It is difficult to judge how representative the sample used
Need for a light arm with effective
in the study is because of a lack of detailed national statistics
mobility of wrist and fingers
Fit of socket (including Shape (especially at the elbow and on the population of prosthesis users. Differentiated reports
on and off) shoulder) on representative samples are rarely made. Representative
Addressing the problem of heat, samples that are reported often do not give detailed descrip-
cold and sweating tions of the type of prosthesis used. Fitting centers can differ
Material (e.g., not causing considerably in the populations they treat; the information
allergies)
Comfort and fit (e.g., padding)
representative for a certain fitting center does not imply the
Appearance More natural size as compared same representation for the national or international popu-
with the size of the natural lation. The centers participating in this survey were selected
hand/arm for practical reasons rather than because they were known to
More natural color (including the be typical of that country. However, the main aim of this
nails) survey was to identify the opinions and experiences of a wide
Surface/material; silicon is too
range of prosthesis users and the distribution of participants.
rough; more waterproof
Different material for the nails The question of why a considerable number of people with
Sound Reduction of sounds of powered upper-limb losses choose not to use a prosthesis was not
movements addressed in this survey. This question needs a different form
Socket noise of survey and questionnaire, similar to that presented in
Movement and grip Separate movement of the fingers Kejlaa.16
function and thumb
Types/shapes of grip
Prevention of objects slipping
Adaptability of grip strength POPULATION
Increased range of movement In the entire survey population, the use of cosmetic pros-
(e.g., more flexibility at wrist) theses is most common. Electric prostheses are used less, and
Increased speed of movement
their use is limited to specific forms of loss. In comparison
More natural looking movements
Increased functionality (e.g., with other studies,16 there was a low proportion of users of
proportional control) mechanical body-powered prostheses in this survey.
Reliable force execution Currently, the use of purely electric prostheses presents an
independent of battery status alternative in cases in which the loss is midradius or below.
Greater intuitiveness of control Although some studies have pointed out considerable advan-
Sensory feedback Increase in sensory feedback
Strength and durability More durable material (especially tages in the use of electric prostheses,18 these are still not
fingers) used as commonly as cosmetic prostheses.
Improved glove material (strain The population in Göteborg has a greater number of
tolerance and dirt resistance) electric prostheses users than do centers in the United King-
Maintenance Easier to don and doff socket dom. This bias may be attributable to early users in Scotland
Increased resistance of the glove to being sent to selected centers5 and the Swedish emphasis in
dirt and chemicals (e.g., nail
fitting powered prostheses early, which leads to greater fa-
varnish)
Reliability Longer lasting batteries miliarity20 and may increase long-term acceptance.21
Improved electronics (better The mean and variance of the ratings of each individual in
protection and more robust 17 qualities was analyzed. This showed individuals’ mean
construction) values ranged from 3.5 to 10 (the latter giving the same
Prevention of the prosthesis getting rating of 10 for all dimensions). The standard deviation of an
“stuck” and “dead positions”
individual’s ratings ranged from 0 (a person giving the same
Reliable precision
rating to all dimensions) to 3.3. In general, the profile in
Figure 1 indicates that users are quite satisfied with the
dissatisfaction with the weight of the device and the fit of the prostheses they use most (none of the mean values is below
socket. 5, which is the value corresponding to the neutral point on
The four participants who only occasionally used cosmetic the scale). This is not surprising because the respondents are
prostheses gave especially low ratings to the fit of the socket those who use their prostheses a great deal and thus are ex-
and aspects of their prostheses’ functionality. This is consis- pected to be reasonably satisfied with them. In addition, other
tent with the findings of other studies.11,17,18 studies have shown that, in general, those who do their devices
Volume 19 • Number 2 • 2007 59
Kyberd et al. JPO Journal of Prosthetics and Orthotics

Figure 3. Areas identified for improvement by users of electric and cosmetic prostheses. Values are expressed as percentages of the number
of respondents in each group, electric (30) and cosmetic (68). Because each person could name as many as three different improvements, the
percentages sum to greater than 100%.

do so for many hours a day11,17,18; they are shown to be com- The ratings of cable hand users (a subgroup of 7 people
mitted users (a possible result of the selection process). subsumed in the group “other”) have profiles similar to those
The different responses can be attributable to real differ- of electric prosthesis users. They are least satisfied with the
ences in satisfaction, but there is some risk that they may, in glove and with aspects of functionality. Cable hand users express
part, be caused by individual differences in the way scales and most satisfaction with maintenance, donning and doffing, fit of
ratings are interpreted (e.g., because of different response the socket, and the “prosthesis as part of oneself.”
sets and reference systems). Response sets imply that a per- The high degree of correlation between the open com-
son limits the usage of the rating scale to certain parts of the ments and the dimensions in the closed questions is encour-
answer (e.g. the positive or neutral area). aging and may be seen as an indicator for the relevance of the
The effect of different reference frames can be that one 17 dimensions identifying the topics of most concern. An
person judges a prosthesis in comparison with the natural hand, alternative explanation is that the correlation may be attrib-
whereas another person refers to experiences with other pros- utable to the ranking of 17 aspects causing users to focus on
theses. Thus, the results will be very different. Tversky22 pre- those topics, biasing even the open questions.
sents the importance of context for quality ratings.
Figure 3 shows that there are considerable differences
One aim of this survey was to identify the improvements seen
between users of cosmetic and electric prostheses when
as most important to the users; thus, the analysis of the aspects
asked to name the three improvements most important to
that are perceived as least satisfactory was key. Even users who
them.
expressed a generally high level of satisfaction usefully contrib-
First, users of cosmetic prostheses could not name as many
uted information as to which aspects are less satisfactory.
Figure 2 presents profiles for the groups who mainly use improvements as users of electric prostheses, having fewer cat-
electric or cosmetic prostheses. However, a considerable num- egories on which to comment. The comments users of cosmetic
ber of users of cosmetic prostheses included functionality in prostheses most often made were concerned with aspects of
their responses. Fraser17 points out that even cosmetic prosthe- appearance, but it should be noted that users of cosmetic pros-
ses often are actively used in daily life. One indication to the theses also cite concern about improvements of movement and
active use of “passive” cosmetic prostheses is the frequency of grip functionality.
their need for repair and the failures that occur. Users of electric prostheses comment mostly on aspects of
Some results are exactly as one might predict from circum- functionality and range of movement, but they also expressed
stances: cosmetic limb users are least satisfied with the glove, concern about appearance and reliability. Other qualities, such
whereas electric prosthesis users express most dissatisfaction as weight, fit of socket, and the prosthesis in daily use, are
with aspects of functionality. Both groups are least satisfied with identified with similar frequency in both groups. The matter of
aspects that can be seen as a central quality of the kind of prosthesis weight is most telling, being a concern even with the
prosthesis they use. lighter prostheses.
60 Volume 19 • Number 2 • 2007
JPO Journal of Prosthetics and Orthotics Survey of Upper-Extremity Prosthesis Users

SATISFACTION their devices. This cannot address reasons others do not use
Although the questions generally resulted in high satis- their prostheses, but it is the opinion of people who regularly
faction ratings for all active users, the high proportion of wear their hands and arms. This opinion is that prostheses are
nonusers known from other studies suggests improvements sufficiently functional and that the users are sufficiently satisfied
in current prostheses are needed. In this context, it is impor- with the result to continue using them. These facts are impor-
tant to identify the improvements of most concern. The tant to stress at this time when providers and payers alike are
empirical results of the current survey show that users of questioning how best to spend money on this population.
electric prostheses were most concerned about aspects of
functionality. Users of electric prostheses and users of cos- CONCLUSIONS
metic prostheses expressed a need for improved appearance of
The survey of users in centers in two different countries
their prostheses. Interviews with prosthetists carried out for
within the European Union shows common concerns and
the ToMPAW project show that these concerns of users are
problems in both countries. The purpose of this survey was to
well known to people working in the field of upper-limb
assist in the design process of a new generation of a pros-
prosthetics.
thetic arm system. The users of electric hands are concerned
An interesting observation in this survey is that different
with function; cosmetic users are concerned with appearance.
centers seem to favor the provision of one kind of prosthesis.
Individuals who do use their prostheses tend to do so all day.
It can be assumed that this is attributable not only to the
specialization of a certain population treated at the limb RECOMMENDATIONS
fitting centers but also to the different philosophies held at
Along with the understandable desires for lighter, more
the centers. This reflects a different attitude than the reason-
reliable, and more anthropomorphic arms, the qualities iden-
ing expressed by Stephens et al.23 that different people prefer
tified from the survey that particularly informed the design
different types of prostheses and that experiences with differ-
choices of the ToMPAW system were:
ent prostheses are an important precondition for a user’s
choice of a prosthesis optimal for his/her individual needs. ● Quiet operation of joints without the sound of brakes
Considering these preferences and needs that inevitably will being applied or removed.
change with time, the development of a modular prosthesis that ● A wide range of grip shapes and good control of the grip
allows for the exchange of modules and the adjustment of force (e.g., not too high an initial grip force).
control strategies within a more stable framework would assist ● Reliable operation, free from breakdowns and interfer-
in maintaining a consistent but reactive provision.1 ence from electrical noise.
● Intuitive control.
CONTEXT These recommendations were taken forward to the engi-
This survey is one of a number reported in the literature. neering phase of the ToMPAW project.1,25
It is only by comparison that there is a possibility of obtaining
a better overall impression of the state of the field. One recent APPENDIX
exception is the survey conducted by Atkins et al.12 The
numbers involved are impressive (more than 2,000 respon- CHARACTERIZATION OF FITTING CENTERS
dents to the short questionnaire). The authors could tailor The three centers involved in the survey were:
the survey and subdivide into different user groupings (body Edinburgh, Scotland. Participants at the fitting center in
power, electric and bilateral users) without diluting the re- Edinburgh are younger and include a high proportion of
sults. The conclusions from that survey are broadly the same women. In comparison, many users of cosmetic prostheses
as those from the current survey, indicating the interests and participated.
needs of the European users are similar to those of the Göteborg, Sweden: Compared with the other centers,
Americans questioned. Göteborg has a high proportion of users of electrical pros-
The primary problem with the survey from a European theses. Participants at this center are slightly older and have
perspective was that the questions concerned the perceived worn prostheses for a longer time than respondents from the
cost of the device. Because both the United Kingdom and other centers.
Sweden have state funding of prostheses supply, the user’s Stockholm, Sweden: The participants at the Stockholm
perception is likely to be bound up with their perceived center include comparatively more patients with limb loss
service from the state health system. As the requirements for above the elbow (55.2%). The users of cosmetic prostheses
the improvement of prosthetic technology, they identify the predominate in this sample.
factors that have been incorporated into advanced prosthetics
systems during the past decade, especially those embodied in ACKNOWLEDGMENTS
the Southampton Hand and the Edinburgh arm systems.24,25 The authors thank the participants of the study for their time
As with many surveys, the responding groups were self- and the detailed answers to the questionnaire. The authors also
selecting, and overwhelmingly they were frequent users of thank the fitting centers for their contribution in organization

Volume 19 • Number 2 • 2007 61

Kyberd et al. JPO Journal of Prosthetics and Orthotics

and data collection. This survey was conducted as part of the 12. Atkins D, Heard DCY, Donovan DH. Epidemiologic overview of
ToMPAW project (DE 420), funded by the Telematics Applications individuals with upper-limb loss and their reported research
Programme of the European Commission. priorities. J Prosthet Orthot 1996;8(1):2–11.

REFERENCES 13. Fraser CM. An evaluation of the use made of cosmetic and
functional prostheses by unilateral upper limb amputees. Pros-
1. Kyberd PJ, Poulton AS, Sandsjö L, et al. The ToMPAW modular
thet Orthot 1998;22:216–223.
prosthesis: A platform for research in upper limb prosthetics.
J Prosthet Orthot 2007;19(1):15–21. 14. Davidson J. A survey of the satisfaction of upper limb amputees
2. Almström C, Herberts P, Korner L. Experience with Swedish with their prostheses, their lifestyles, and their abilities. J Hand
multifunctional prosthetic hands controlled by pattern recog- Ther 2002;28(1):62–70.
nition of multiple myoelectric signals. Int Orthop 1981;5(1): 15. Millstein SG, Heger H, Hunter GA. Prosthetic use in adult upper
15–21. limb amputees: a comparison of the body powered and electri-
3. Gow DJ, Dick TD, Draper ERC, et al. The physiologically appro- cally powered prostheses. Prosthet Orthot Int 1986;10:27–34.
priate control of an electrically powered hand prosthesis. Pre-
16. Kejlaa GH. Consumer concerns and the functional value of
sented at: International Society of Prosthetics and Orthotics 4th
prostheses to upper limb amputees. Prosthet Orthot Int 1993;
World Congress; September 1983; London, United Kingdom.
17:157–163.
4. Kyberd PJ. The Algorithmic Control of a Multifunction Hand
17. Fraser C. A survey of users of upper limb prostheses. Br J Occup
Prosthesis [PhD thesis]. Southampton University, United
Ther 1993;56(5):166–168.
Kingdom; Electrical Engineering Department, 1990.
5. Kyberd PJ, Beard DJ, Morrison JD. The population of users of 18. Weaver SA, Lange LR, Vogts VM. Comparison of myoelectric and
upper limb prostheses in Oxfordshire. Prosthet Orthot Int 1997; conventional prostheses for adolescent amputees. Am J Occup
21(2):85–91. Ther 1988;42(2):87–91.

6. Bergman K, Örnholmer L, Zackrisson K, Thyberg M. Functional 19. Burroughs SF, Brook JA. Patterns of acceptance and rejection of
benefit of an adaptive myoelectric prosthetic hand compared to upper limb prostheses. Orthot Prosthet 1985;39(2):40–47.
a conventional myoelectric hand. Prosthet Orthot Int 1992;16:
20. Sörbye R. Upper-limb amputees: Swedish experiences concern-
32–37.
ing children. In: Atkins DJ, Meier RH, eds. The Comprehensive
7. Miller LA, Lipschutz RD, Weir RW, et al. Shoulder disarticulation Management of the Upper-Limb Amputee. New York: Springer-
fitting with six independently controlled motors after targeted Verlag; 1988:227–239.
hyper-reinnervation nerve transfer surgery. Presented at: Myoelec-
21. Heger H, Millstein S, Hunter GA. Electrically powered prosthe-
tric Controls Symposium; August 25–27, 2005; Fredericton, New
ses for the adult with an upper limb amputation. J Bone Joint
Brunswick, Canada.
Surg Br 1985;67(2):278–281.
8. Jones B, Kyberd PJ. Improved control for an artificial arm.
Presented at: Myoelectric Controls Symposium; August 25–27, 22. Tversky B. Features of similarity. Psychol Rev 1977;84(4):
2005; Fredericton, New Brunswick, Canada, pp. 43– 48. 327–352.

9. Baits JC, Todd RW, Nightingale JM. The feasibility of an adaptive 23. Stephens K, Stephens J, Fairley M. Electronic technology aids
control scheme for artificial prehension. Proceedings of a Sym- UE amputees. Orthotics and Prosthetics Business World 1999;
posium at the Institute of Mechanical Engineering, 1968;183: 2(1):42–46.
54–59.
24. Gow D, Douglas W, Geggie C, et al. The development of the
10. Nightingale JM. Microprocessor control of an artificial arm. Edinburgh Modular Arm System. Proceedings of the Institution
J Microcomput Appl 1985;8:167–173. of Mechanical Engineers Part H 2001;215:291–298.

11. Kyberd PJ, Beard DJ, Davey JJ, Morrison DJ. Survey of upper 25. Poulton A, Kyberd PJ, Gow D. Progress of a modular prosthetic
limb prostheses users in Oxfordshire. J Prosthet Orthot 1998; arm. In: Keates S, Langdon P, eds. Universal Access and Assis-
10(4):85–91. tive Technology. London: Springer; 2002:193–200.

62 Volume 19 • Number 2 • 2007