Appropriateness of advanced upper limb prosthesis prescription for a patient with cognitive impairment: a case report.
Appropriateness of advanced upper limb prosthesis prescription for a patient with cognitive impairment: a case report.
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认知障碍患者高级上肢假肢处方的适当性：病例报告。
DOI：
10.1080/17483107.2016.1201155
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Resnik,Linda
中科院分区：
文献类型：
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作者：
Barredo,Jennifer;Acluche,Frantzy;Disla,Roxanne;Fantini,Christopher;Fishelis,Leah;Sasson,Nicole;Resnik,Linda
目的：描述一名肩胛骨-胸椎截肢和认知障碍患者接受使用DEKA臂的训练，并讨论与确定他不适合独立在家使用该装置相关的因素。方法：参与者使用DEKA手臂高级上肢假体进行40小时的实验室训练。收集训练前的认知神经心理测量。在训练10小时后和训练结束时，收集与功能表现、生活质量和疼痛相关的定性和定量数据。采用不断比较的方法，数据被分成几个主要主题；确定了每个主题中的元素。结果：六个主题与确定参与者不适合在家使用DEKA手臂相关：身体和心理健康；学习、记忆和认知；成人角色功能；功能性能;用户安全、判断和独立使用设备的能力。禁止在无人监督的情况下使用设备的问题包括：无法控制的健康症状、知识应用不良、安全问题、缺勤和压力下的表现下降。结论：研究结果对DEKA臂和其他复杂上肢假体的训练和处方具有指导意义。需要进一步研究建立一个模型来指导技术复杂的上肢假体的处方。对康复的启示高级上肢假肢，如DEKA手臂，承诺更大的功能，但也可能对认知有要求，这就提出了一个问题，即什么时候，以及处方是否适合认知障碍患者。目前，还没有正式的标准来指导高级上肢假体的处方。每个临床团队在决策时采用自己的非正式标准。在本病例报告中，我们描述了六个因素，在确定研究参与者，肩胛骨-胸椎截肢和认知障碍是否适合在家中使用复杂的上肢假体。研究结果对DEKA臂的训练和处方有启示意义，并强调需要进一步研究以制定高级辅助装置的处方指南。
Purpose:To describe a participant with scapulo-thoracic amputation and cognitive impairment trained to use the DEKA Arm and discuss factors relevant to the determination that he was not an appropriate candidate for independent home use of the device.Method: The participant underwent 40 h of in-laboratory training with the DEKA Arm Advanced Upper Limb Prosthesis. Pre-training neuropsychological measures of cognition were collected. Qualitative and quantitative data related to functional performance, quality of life and pain were collected after 10 h of training, and at the conclusion of training. Using a constant comparative approach, data were binned into major themes; elements within each theme were identified.Results:Six themes were relevant to the determination that the participant was inappropriate for home use of the DEKA Arm: physical and mental health; learning, memory and cognition; adult role function; functional performance; user safety and judgement and capacity for independent device use. Issues contraindicating unsupervised device use included: uncontrolled health symptoms, poor knowledge application, safety concerns, absenteeism and performance degradation under stress.Conclusion:The findings have implications for training with and prescription of the DEKA Arm and other complex upper limb prostheses. Further research is needed to develop a model to guide prescription of technologically complex upper limb prostheses.Implications for RehabilitationAdvanced upper limb prostheses, like the DEKA Arm, promise greater functionality, but also may be cognitively demanding, raising questions of when, and if, prescription is appropriate for patients with cognitive impairment.At this time, no formal criteria exist to guide prescription of advanced upper limb prostheses. Each clinical team applies their own informal standards in decision-making.In this case report, we described six factors that were considered in determining whether or not a research participant, with scapulo-thoracic amputation and cognitive impairment was appropriate for home use of a complex upper limb prosthesis.The findings have implications for training with and prescription of the DEKA Arm, and highlights the need for further research to develop prescription guidelines for advanced assistive devices.