Protocol S1. Protocol. - 1 st Session. Prosthesis orientation. Componentry training. Donning and doffing. Body control motions.

Transcription

1 Prtcl S1 Prtcl - 1 st Sessin Prsthesis rientatin Cmpnentry training Dnning and dffing Bdy cntrl mtins Assessment Bdy cntrl mtins, terminal device adjustment, ranges f pening, and use at varius heights. Task Training Blcked rder Indirect grasping 4 trials with each f the three bjects resulting in 12 trials. All fur trials fr an bject will be cmpleted befre mving n t the next bject. Direct grasping Same structure as indirect grasping Fixatin 4 trials fr each f the three tasks resulting in 12 trials. All fur trials fr a task will be cmpleted befre mving n t the next bject. Free training 5 minutes sitting and 5 minutes standing mshap - 2 nd Sessin Dnning Assessment Bdy cntrl mtins, terminal device adjustment, ranges f pening, and use at varius heights Bx and blcks test Task training Randm rder Indirect grasping, direct grasping, and fixatin tasks will be randmized. Only tw trials f each task/bject cmbinatin will be perfrmed. Free Training 5 minutes sitting and 5 minutes standing 1

2 Activities f Daily Living Blcked rder Unilateral ADL tasks will be perfrmed first, fllwed by the bilateral ADL tasks as time allws within the 20 minutes allcated. mshap - 3 rd Sessin Dnning Assessment Bdy cntrl mtins, terminal device adjustment, ranges f pening, and use at varius heights Bx and blcks test Task training Randm rder Indirect grasping, direct grasping, and fixatin tasks will be randmized. Only tw trials f each task/bject cmbinatin will be perfrmed. Free Training 5 minutes sitting and 5 minutes standing Activities f Daily Living Randm rder ADL tasks will be perfrmed in randm rder. mshap 2

3 PROSTHESIS ORIENTATION Cmpnentry Training Intrduce the majr cmpnents f the prsthesis, namely the harness, the cntrl cable, the wrist unit, and the terminal device (TD) while pinting ut each n the bypass t the participant. Describe the cntrl cables ability t vluntarily pen the TD against passive clsure due t the rubber bands. All participants will use the prsthesis with tw rubber bands. Have the bypass prsthesis, with the cntrl cable detached, n the table. The bdy-pwered bypass prsthesis cnsists f fur majr cmpnents. The harness, which will fit ver yur shulders and back, the wrist unit, which will fit ver yur frearm, the TD which will functin in place f yur hand, and the cntrl cable, which will cnnect the harness t the TD such that certain mvements will pen and clse the TD. The rubber band n the TD will then cause passive clsure. Taking a clser lk at the TD we nte this lever here, ften referred t as the thumb, it can be a useful additinal pint f cntact during tasks. Additinally, we can see where the rubber grip extends alng the hk, the ntch in the grip right at the crner, and hw the hks mve and align in relatin t ne anther. Keeping these aspects in mind will help yu t use the prsthesis as efficiently as pssible. [Pint ut each cmpnent as yu discuss. Pull n the cntrl cable t demnstrate vluntary pening f the TD.] Demnstrate and discuss the ability t pre-psitin/rtate the TD by pressing the lever and then pushing the TD t seat it again. Stress the imprtance f this in maximizing prsthesis functinality. The TD can be rtated by pressing this lever t release and then pushing the TD in t seat again, indicated by the click yu hear. This feature is imprtant t cnsider due t the inability t rtate the wrist unit. Therefre, prir t starting a task, time shuld be taken t think thrugh the necessary grip and t rtate the TD accrdingly. [Demnstrate the ability t rtate and seat the TD.] DONNING AND DOFFING Help the participant int the prsthesis while describing each step such that the participant can dn the prsthesis withut assistance in the future. The cntrl cable shuld be discnnected during dnning and dffing t prevent damaging the prsthesis. Adjust the harness straps preemptively erring n the side f t tight based n the size f the participant (it is simpler t lsen the straps than t tighten). 3

4 Place yur right hand thrugh the anterir supprt strap, thrugh the wrist unit, and grasp the handle. Tighten the straps n yur frearm. Take yur ther hand and insert thrugh the axilla lp. [Assist the participant dnning the prsthesis. In rder adjust the axilla lp tensin, the anterir supprt strap, y straps, and then the cntrl strap. Cntinually engage the participant ensuring the fit is cmfrtable and secure. The ring harness shuld be inferir and t the sund side f the vertebra prminens; the y-strap shuld rest at the axilla.] BODY CONTROL MOTIONS The prsthesis is cntrlled thrugh tw main bdy cntrl mtins, shulder flexin/extensin and scapular prtractin. Describe and demnstrate each mtin and have the participant mirrr yur mtins. Stress the imprtance f thinking and selecting frm these cntrl mtins prir t perfrming a task. The TD can be pened thrugh specific bdy cntrl mtins. Shulder flexin/extensin and scapular prtractin, which can be perfrmed in 3 ways: Bypass side, sund side, r biscapular. It is imprtant t think thrugh these cntrl mtins and select a strategy befre perfrming a task. [Demnstrate each mvement as yu discuss it and have the participant mirrr yur mtins.] Give the participant additinal time t try each mtin n their wn and ffer t make any adjustments t the harness nw. 4

5 1 ST ASSESSMENT A general assessment f prsthesis cntrl, prir t task training, will be perfrmed t ensure participants have an adequate understanding f the prsthesis in rder t cmmunicate effectively and t use the prsthesis safely. Befre mving n t wrk with actual bjects and grasping we need t g thrugh a quick assessment t ensure yu understand hw t prperly use the prsthesis. Have the participant demnstrate bdy cntrl mtins, adjustment and seating f the TD, varius ranges f TD pening and clsing, and varius heights f wrist unit during pening and clsing. This assessment is nt designed t be restrictive, if the participant answers incrrectly prmpt them with an explanatin and quick demnstratin and ask them t repeat. Open and clse the TD using shulder flexin/extensin. Open and clse the TD using bypass side scapular prtractin Open and clse the TD using sund side scapular prtractin. Open and clse the TD using biscapular prtractin. Adjust the TD rientatin and reseat it. Using any bdy cntrl mtin yu like pen the TD fully pen the TD half-way. Using any bdy cntrl mtin yu like pen the TD at waist level at chest level at face level. [Engage participant and adjust any straps as needed. Observe when the TD begins pening thrugh the bdy cntrl mtin and ensure harness fit allws prper activatin.] Participants must demnstrate mastery f these skills prir t mving n t task training. Cntinue caching and repeating this assessment as necessary until the participant cmpletes it satisfactrily. Again, ffer t make any adjustments t the prsthesis nw. 5

6 BOX AND BLOCKS TEST The Bx and Blck Test (BBT) measures unilateral grss manual dexterity and invlves transprting as many blcks as pssible frm ne side f the bx, ver a partitin, t the ther side in a minute. The BBT shuld be administered immediately fllwing the initial assessment in each sessin, excluding the 1 st sessin. The test bx is placed lengthwise alng a line 5 inches frm the edge f the table. The participant shuld be seated with the table at a height that allws their hands t rest n tp f the bx with their bypass side elbw at 90 degrees and their hands n either side f the bx. 150 blcks shuld be in the right cmpartment. The examiner shuld face the participant t view the test. I want t see hw quickly yu can pick up ne blck at a time with the prsthesis [pint t prsthesis], carry it t the ther side f the bx, and drp it. Make sure the TD crsses the partitin. Watch me while I shw yu hw. [Transprt three cubes ver the partitin in the same directin yu want the participant t mve them.] If yu pick up tw blcks at a time, they will cunt as ne. If yu drp ne n the flr r table after yu have carried it acrss, it will still be cunted, s d nt waste time picking it up. If yu tss the blcks withut yur fingertips crssing the partitin, they will nt be cunted. Befre yu start, yu will have a chance t practice fr 15 secnds. D yu have any questins? Then place yur hands n the sides f the bx. When it is time t start, I will say ready and then g. Ready G Stp [Start the watch at the wrd g. When 15 secnds has passed, say stp. Infrm the participant f any mistakes they may have made during the practice perid. Reset the test.] This will be the actual test. The instructins are the same. Wrk as quickly as yu can. Ready G Stp [Start the watch at the wrd g. When 1 minute has passed, say stp. Remve blcks that weren t prperly transprted. Cunt and recrd the number f blcks. Reset the test.] The test shuld be repeated when the participant is ready fr a ttal f 3 trials. 6

7 TASK TRAINING OVERVIEW The participant will perfrm 3 frms f basic bject manipulatin tasks. Indirect grasping (IG) and direct grasping (DG) tasks will fllw the same prcedure fr each trial but will utilize 3 different bjects; a wden blck, a fam ball, and a metal can. Fixatin tasks will invlve 3 unique tasks. These tasks will be perfrmed seated. In blcked rder sessins all 4 trials fr an bject/task will be cmpleted befre mving n t the next bject/task. In the randm rder sessins bjects/tasks will be randmized and nly 2 trials will be perfrmed fr each bject/task cmbinatin. Tasks will be perfrmed n a table tp with standardized dimensins and site lcatins fr hands and bjects. The template is designed t cver a 122 x 77 cm table tp. The far hrizntal line (the mshap line) marks 20 cm frm the near edge f the table; the vertical line marks the midline f the table. Each circle is 10 cm in diameter. The left and right circles centers are bth 40 cm frm the near edge f the table and 20 cm frm midline. The mid circle s center is 25 cm frm the near edge f the table. The squares (hme) are aligned vertically with the left and right circles, are centered 10 cm frm the near edge f the table and are 10 x 10 cm. The shrt hrizntal line between the hme squares (the BBT line) is 5 inches frm the near edge f the table. Outlines f the 3 x 3 cm blck and 8 cm diameter can used in training can be fund in the mid and right circles. These can be used as an additinal challenge fr participants by prmpting them t release the bject within the shape in either grasping task. The table template is used t guide the tasks. Lcatins labelled n the template are referred t as right circle, left circle, and mid circle in the task instructins. Midline refers t the vertical line centered in the template. Hme refers t the 2 squares. The mshap line refers t the far hrizntal line. The BBT line refers t the hrizntal line between the hme squares. Have the wden blck, fam ball, and metal can nearby. The table shuld be clear except fr the template. The participant shuld be seated with their midline aligned with the vertical line n the table template. 7

8 Nw we ll mve n t bject manipulatin tasks. Each grasping task will be perfrmed 4 times each fr 3 different bjects. The grasping tasks are either IG, in which the bject is placed int the TD with the free hand, r direct grasping, in which the bject is picked up directly with the TD. Each f the 3 fixatin tasks will be cmpleted 4 times. The fixatin tasks invlve cmpleting a task with yur free hand while using the TD t stabilize, r fixate, the bject. These tasks will nt be timed and are fr training purpses nly, therefre we encurage yu t take yur time and discuss each task. Fr the 1st trial f each bject/task prmpt the participant t explain the grip strategy and bdy cntrl mtin that they plan t use prir t starting the task. Befre beginning the task I want yu t plan yur strategy and explain it t me. Be sure t include TD rientatin, hw the bject will be situated in the grip, and bdy cntrl mtins fr bth grasp and release. Befre the 2 nd trial, prmpt the participant t describe any difficulties they fund during the 1st trial and any changes they plan t make in their secnd attempt. What difficulties did yu find with the task and with yur particular strategy? Hw d yu plan n perfrming the task differently this time? Befre the 3 rd trial ffer any caching n strategy if apprpriate. Finally, befre and after the 4 th trial ffer feedback n what wrked in their strategies and what can be imprved. [Prmpts fr the 3rd and 4th trials will be based n the participants unique perfrmance and can t be standardized. Suggestins cmmnly fcus n TD rientatin, islatin f bdy cntrl mtins during tasks, use f cmpensatry mvements, etc.] INDIRECT GRASPING IG tasks invlve placing an bject int the grip f the TD using the free hand. The bject will begin in the left circle, be grasped by the left hand, transferred t the TD in midair at the midline, and be released in the right circle. Bth hands will start at hme. Place ne f the bjects in the left circle. First we ll d the IG tasks. A series f bjects will be placed n the table in frnt f yu in the left circle and yu will mve them t the right circle as labeled n the table. In this task yur hands will start at hme, yu will grasp the bject in yur left hand frm the left circle. Yu will transfer the bject t yur TD at the midline in 8

9 midair. Yu will then place that bject in the right circle and release it using nly the TD. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial.] DIRECT GRASPING DG tasks invlve picking up and mving an bject slely with the TD. The bject will begin in the right circle, be grasped by the TD, and released in the mid circle. Bth hands will start at hme. Place ne f the bjects in the right circle. Nw we ll mve t DG tasks. A series f bjects will be placed n the table in frnt f yu in the right circle and yu will mve them t the mid circle as labeled n the table. In this task yur hands will start at hme, yu will grasp the bject with yur TD frm the right circle. Yu will then place that bject in the mid circle and release it using nly the TD. [Demnstrate the prcedure yurself while explaining the task t the participant. Reset the bject fllwing yur demnstratin and after each trial. Deliver the apprpriate prmpt fr each trial] FIXATION FIX tasks invlves perfrming a task with the free hand while the TD acts as a stabilizer. The bjects are centered ver the mid circle. RULER TASK Participants will fixate (r hld steady) a ruler between tw dts drawn n a piece f paper 20 cm apart with the TD. Using their free hand and the ruler they ll draw a straight line between the tw dts. The participant can use their free hand t mve the ruler but must use the prsthesis t fixate the ruler while drawing. Bth hands will begin at hme. The piece f paper shuld be centered ver the mid circle with the ruler situated alng the tw dts drawn 20 cm apart. The pen shuld start in the left circle. Nw we ll mve t FIX tasks. In this task yu will use the TD t fixate, r stabilize, the ruler between the tw dts n the paper in frnt f yu. Yu will use yur left hand t draw a straight line between the dts. Yur hands will start at hme, yu will grasp the pen frm the left circle, yu will draw a straight line between tw dts 9

10 using the ruler, yu will fixate the ruler with the TD, and then yu will release the pen in the left circle. [Demnstrate the prcedure yurself while explaining the task t the participant. Reset the bject fllwing yur demnstratin and after each trial. Deliver the apprpriate prmpt fr each trial] ZIPPER TASK In the secnd task participants will fixate a piece f clth with a zipper using the TD. Using their left hand, they ll pen and clse the zipper. Bth hands will begin at hme. The zipper shuld be centered ver the mid circle. The zipper shuld be fully zipped. In this task yu will use the TD t fixate the clth in frnt f yu. Yu will use yur left hand t unzip the zipper fully and then zip the zipper clsed. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial] BUTTON TASK In the third task the participant will fixate a piece f clth with fur buttns with the TD. Using the free hand, they ll unbuttn each buttn. Bth hands will begin at hme. The buttn bard shuld be centered at the mid site with the buttns aligned hrizntally. In this task yu will use the TD t fixate the bard in frnt f yu. Yu will use yur left hand t grasp the clth and unbuttn each buttn. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial] 10

11 FREE TRAINING Allw the participant 12 minutes t use the prsthesis as they wish. Encurage them t interact with the bjects laid ut n the table. Participants will remain seated, with the table at the sitting height, fr 5 minutes and then will stand, with the table at the standing height, fr the remaining 5 minutes. Table full f free training materials fr use by the participant 11

12 ACTIVITIES OF DAILY LIVING OVERVIEW 12 ADLs have been chsen t prvide additinal training. Participants shuld be encuraged t discuss strategies with the research assistant. Each ADL will be perfrmed twice. In the blcked rder sessins, the unilateral tasks and then the bilateral tasks will be perfrmed in the rder they appear belw. In the randm rder sessins, the task trials will be randmized. ADL training will last fr 20 minutes, independent f the number f tasks perfrmed within that time, t give the participant and the research assistant flexibility in training. Only the prsthesis shuld be used in unilateral tasks unless therwise stated. The prsthesis and free hand can bth be used in bilateral tasks. The table shuld be cleared except fr the table template. The ADL materials shuld be nearby and ready fr use. Nw we re ging t wrk thrugh sme activities f daily living, r ADLs, these tasks are based n real-life tasks and require cmbinatins f mvements and mre cmplex strategies. We encurage yu t discuss mvement strategies with us prir t starting a task and t actively think thrugh yur mvements. Fr the 1st trial f each bject/task prmpt the participant t explain the grip strategy and bdy cntrl mtin that they plan t use prir t starting the task. Befre beginning the task I want yu t plan yur strategy and explain it t me. Be sure t include TD rientatin, hw the bject will be situated in the grip, and bdy cntrl mtins fr bth grasp and release. Befre the 2 nd trial, prmpt the participant t describe any difficulties they fund during the 1st trial and any changes they plan t make in their secnd attempt. What difficulties did yu find with the task and with yur particular strategy? Hw d yu plan n perfrming the task differently this time? Befre mving n t the next task give feedback n their strategy, what wrked and what didn t, and anything they may have dne differently. [Feedback fllwing the 2nd trial will be based n the participants unique perfrmance and can t be standardized. Suggestins cmmnly fcus n TD rientatin, islatin f bdy cntrl mtins during tasks, use f cmpensatry mvements, etc.] UNILATERAL TASKS BRUSH HAIR 12

13 Instruct the participant t grasp the brush, bring the brush t their head, brush their hair r perfrm a brushing mtin, and release the brush frm grasp. The cmb shuld be aligned hrizntally and centered in the mid circle. The participant shuld be standing with bth hands at hme. Please take this brush and, while grasping it, run it thrugh yur hair (r ver the tp f their head if bald). Then put the brush dwn in the mid circle. Try t use nly yur prsthesis t d this task. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] DRINK FROM A CUP Instruct the participant t pick up the cup frm the table, bring the cup t their muth, tilt the cup and simulate drinking, return the cup t the table in the mid circle, and release their grip n the cup. The cup shuld be centered in the mid circle. The participant shuld be standing with bth hands at hme. Pick up this paper cup frm the table, bring it all the way t yur muth, and pretend t drink frm it. Then put the cup back n the table in the mid circle. Try t use nly yur prsthesis t d this task. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] USE A FORK Instruct the participant t grasp the frk, use the frk t stab the plasticine, bring the frk and plasticine all the way t the muth as if taking a bite f fd, mve the frk away frm their muth and return it t the mid circle, and release their grip n the frk. The frk shuld be aligned vertically and centered in the mid circle. The plasticine shuld be shaped int a ball and centered in the left circle. The participant shuld be sitting with bth hands at hme. Please grasp this frk, stab the plasticine, and bring it t yur muth as if yu were ging t take a bite f fd frm it. Then put the frk back n the table in the mid circle. Try t use nly yur prsthesis t d this task [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] USE A SPOON 13

14 Instruct the participant t grasp the spn, use the spn t scp bean(s) frm the bwl, bring the spn and bean(s) all the way t their muth as if taking a bite f fd, mve the spn away frm their muth, depsit the bean(s) in the bwl, return the spn t the mid circle, and release their grip n the spn. The spn shuld be aligned vertically and centered in the mid circle. The bwl f beans shuld be centered in the right circle. The participant shuld be sitting with bth hands at hme. Please grasp this spn with yur prsthesis, use it t scp a bean(s) frm the bwl, and bring the spn and bean(s) t yur muth as if yu were ging t take a bite frm it. Then put the bean(s) back in the bwl and the spn back n the table in the mid circle. Be sure t use yur prsthesis while ding this. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] POUR FROM A CAN Instruct the participant t pick up the can, pur the cntents int the cup, set the can dwn n the table, and release the can. The can shuld be filled with 100 ml f water and centered in the mid circle, with the tab pen and pinting t the far edge f the table. The cup shuld be centered in the left circle. The participant shuld be sitting with bth hands at hme. Please pick up the sda can frm the table. Then pur the water frm the can int the cup, making sure nt t spill any water. When finished set the can dwn n the table upright in the mid circle. Be sure t use yur prsthesis. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] WRITE LEGIBLY Instruct the participant t grasp the pen, write the wrd LETTER, set the pen dwn n the table in the mid circle, and release their grip The paper shuld be aligned vertically, centered ver the mid circle. The pen shuld be aligned vertically with the tip twards the participant, centered ver the right circle. The pen shuld be clicked clse. The participant shuld be sitting with bth hands at hme. Please grasp this pen with yur prsthesis, click it pen, and write the wrd LETTER n the blank sheet f paper n the table. Then set the pen dwn n the table in the right circle. Try t use nly yur prsthesis t d this task. Yu may use yur left hand t stabilize the paper 14

15 [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] BILATERAL TASKS ZIP VEST Instruct the participant t dn the vest, initiate the zipper, pull the zipper up at least tw thirds f the way, and then unzip the zipper. The vest shuld be laid with the cllar twards the far edge f the table, unzipped with the frnt facing upwards, centered ver the mid circle. The participant shuld be standing with bth hands at hme. Please put this vest n (therapist may help dn vest), start the zipper, and pull it at least tw-thirds f the way up. Then unzip the zipper. Be sure t use yur prsthesis while ding this. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] TIE SHOELACES Instruct the participant t grasp a lace with each hand, crisscrss the laces, make lps, pull the bw tight, and release their grasp n the laces. The she shuld be psitined with the te clsest t the far edge f the table, centered ver the mid circle. The participant shuld be standing with bth hands at hme. Please take this she and tie the laces. Grasp a lace in each hand, crisscrss the laces, making lps, and tie the bw tight. Be sure t use yur prsthesis while ding this. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] FOLD A BATH TOWEL Instruct the participant t grasp the ends f the twel, lift the twel ff the table, bring the ends tgether t fld twice in tw different directins, and release their grasp n the twel. The twel shuld be centered ver the mid circle. The participant shuld be standing with bth hands at hme. 15

16 Please grasp the ends f this bath twel and hld the twel ff the table, then bring the ends f the twel tgether t fld it twice in tw different directins. Place the flded twel back n the table. Be sure t use yur prsthesis while ding this. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] OPEN AN ENVELOPE Instruct the participant t grasp the envelpe in the TD, use a pen break the tp seal f the envelpe, pen the envelpe, remve the paper within the envelpe, place the envelpe and cntents ver the mid circle and the pen in the left circle, and release the envelpe, its cntents, and the pen. The envelpe shuld be centered ver the mid circle. The pen shuld be riented vertically, tip pinting dwn, centered in the left circle. The participant shuld be sitting with bth hands at hme. Please secure this envelpe and, using a pen, break the seal n it. Then pen the envelpe, remve it cntents, and place bth n the table ver the mid circle. Return the pen t the left circle. Be sure t use yur prsthesis while ding this. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] TAPE MEASURE Instruct the participant t grasp the tape measure, extend the tape t measure between the mid circle and the right circle, withdraw the tape, place the tape measure ver the mid circle, and release their grip. The tape measure shuld be centered in the left circle, with the tape withdrawn and riented n the right. The participant shuld be sitting with bth hands at hme. Please grasp the tape measure and measure the distance between the bundaries f the mid circle and the right circle. Then withdraw the tape and place it in the mid circle. Be sure t use yur prsthesis while ding this. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task.] OPEN A BAG Instruct the participant t grasp the Ziplc bag, pen the bag in the air (withut fixating against the table), grasp the pen, place the pen in the Ziplc bag, seal the bag, place the bag in the mid circle, and release their grip. 16

17 The Ziplc bag shuld be centered ver the mid circle. The pen shuld be aligned hrizntally, centered in the left circle. The participant shuld be standing with bth hands at hme. Please grasp the Ziplc bag and, hlding it ff the table, grasp the pen and place it in the bag. Then seal the bag and place it back n the table ver the mid circle. Be sure t use yur prsthesis while ding this. [Demnstrate the prcedure yurself while explaining the task t the participant. Deliver the apprpriate prmpt fr each trial. Reset the task. Dn t allw the participant t fixate the bag r pen against their bdy.] 17

18 MODIFIED SOUTHAMPTON HAND ASSESSMENT PROCEDURE OVERVIEW The Suthamptn Hand Assessment Prcedure (SHAP) is based n the analysis f grip patterns, and their frequency f use in Activities f Daily Living (ADL) tasks. In this mdified versin changes have been made t accmmdate bdy-pwered bypass prsthesis use and t simplify the prcess f scring. The participant shuld be seated with the table at the apprpriate height. Fr each f the tasks the bard shuld be mved frm left t right s that each task is directly in frnt f the participant s prsthesis. Each task shuld be demnstrated t the participant using slw and clear mvements. Participants can practice each task fr a maximum f 1 minute, prir t timing it, t determine the mst apprpriate technique. Only a single attempt will be allwed fr each task, excluding errrs assciated with the timer. Incmplete attempts shuld be recrded as c/c (culd nt cmplete); these include significant spills, an bject falling frm the bard r case, an incrrect final psitin (ie. the bject is nt in the slt), and use f any bdy part ther than the TD unless therwise specified. Participants shuld be instructed t cntinue the task t cmpletin t avid c/c even in the event f errrs. During practice the administratr shuld pint ut any attempts that wuld be cnsidered incmplete t ensure errrs are assciated nly with executin and nt understanding. In the apprpriate frms (See Appendix) the time and any additinal ntes shuld be recrded. Additinally, the quadrant chice in the bypass assessments shuld be recrded. The quadrant chice is a means t identify the rientatin f the TD defined by the directin f the hk relative t the wrist unit. 18

19 The directin that the end f the hk pints relative t the wrist unit falls int ne f fur different quadrants when recrding the rientatin f the TD. The mshap is divided int abstract bjects, heavyweight and lightweight, and ADLs, bard and case. The abstract bjects task shuld be randmized, including bth heavyweight and lightweight versins, and perfrmed first. The ADL tasks shuld be randmized nly within their respective grups f bard r case and perfrmed secnd. Which grup begins within the ADL prtin, bard r case, shuld additinally be randmized. Nw we ll cnduct a mdified versin f the Suthamptn Hand Assessment Prcedure r mshap t establish yur functinality with the bypass prsthesis. This prcedure cnsists f a series f grasping tasks with 12 different abstract bjects and a series f 10 activities f daily living, r ADLS. Yur functinality will be determined by hw quickly yu cmplete each task. 1 minute f practice will be allwed prir t each task t wrk thrugh different strategies n yur wn. Only a single attempt will be allwed fllwing practice, excluding any errrs assciated with the timer. Any task cnsidered incmplete fllwing the stpping f the timer will be recrded as culd nt cmplete resulting in the maximum allwed time, therefre d nt stp the timer fllwing an errr until a task is cmpleted r until I tell yu t stp. I can additinally cnfirm crrect cmpletin f a task during the practice time. ABSTRACT OBJECTS Bth lightweight and heavyweight versins fllw the same prcedure; the lightweight bjects are the wden versins, while the heavyweight bjects are metal. Each bject will be mved frm its crrespnding rear slt t the frnt slt using the right hand. Place the SHAP bard n the table blue side up. Align the frnt edge f the bard with the mshap line n the table template. Have all the abstract bjects ut f the case and rganized n a table nearby. Have the participant sit at the table with their midline aligned with the vertical line n the table template. A series f bjects will be placed n the bard. The task invlves mving the bject frm the rear slt n the bard t the frnt slt. Only the hand under assessment (dminant hand) shuld be used fr any f these tasks, including the starting and stpping f the timer. [Pint ut the rear slt and the frnt slt fr an abstract bject] 19

20 Diagram f the abstract bjects (left) and the abstract bjects side f the SHAP bard labeled fr each bject (right). The bject labeled cylinder crrespnds t the pwer grip tasks. SPHERICAL Place the spherical bject in its rear slt. Place the heavyweight tip bject in the slt between the rear and frnt spherical bject slts t create a small barrier. Align the bject with the participant s dminant hand. Start the timer, pick up and mve the bject as demnstrated with as few mistakes as pssible, and as quickly as pssible, t the frnt slt. Cmplete the task by depressing the blue buttn n the timer again. [Use the spherical grip t mve the bject ver the barrier and place it in the frnt slt and reset the task afterwards. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] TRIPOD Place the tripd bject in the apprpriate rear slt. Align the bject with the participant s dminant hand. Start the timer, mve the bject as demnstrated and as quickly as pssible t the frnt slt and then stp the timer. [Use a tripd grip t mve the bject t the frnt slt and reset the task afterwards. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] POWER Place the pwer bject in the apprpriate rear slt. Align the bject with the participant s dminant hand 20

21 Start the timer, mve the bject as demnstrated and as quickly as pssible t the frnt slt and then stp the timer. [Use a pwer grip t mve the bject t the frnt slt and reset the task afterwards. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] LATERAL Place the lateral bject in the apprpriate rear slt with the handle facing tward the participant. Align the bject with the participant s dminant hand Start the timer, mve the bject as demnstrated and as quickly as pssible t the frnt slt and then stp the timer. [Use a lateral grip t mve the bject t the frnt slt, using the handle, and reset the task afterwards. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] TIP Place the tip bject in the apprpriate rear slt. Align the bject with the participant s dminant hand. Start the timer, mve the bject as demnstrated and as quickly as pssible t the frnt slt and then stp the timer. [Use a tip grip t mve the bject t the frnt slt and reset the task afterwards. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] EXTENSION Place the extensin bject in the apprpriate rear slt. Align the bject with the participant s dminant hand. Start the timer, mve the bject as demnstrated and as quickly as pssible t the frnt slt and then stp the timer. [Use an extensin grip t mve the bject t the frnt slt and reset the task afterwards. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] ACTIVITIES OF DAILY LIVING 21

22 The ADL side f the SHAP bard labeled fr each task and the lcatins f the crrespnding bjects. Place the SHAP bard n the table white side up. Align the frnt edge f the bard with the mshap line n the table template. Have all the ADL bjects ut f the case and rganized n a table nearby. Have the participant sit at the table with their midline aligned with the vertical line n the table template. Fill the jar t the tp f the label with water fr use in Mving a heavy bject, Jug puring, and Cartn puring tasks. The secnd stage f this assessment cnsists f 10 everyday activities, which shuld be timed in the same manner by pressing the blue buttn t start and stp the timer. Again, tasks shuld be cmpleted as quickly as pssible, with as few mistakes as pssible, using nly the apprpriate hand unless therwise stated. Bard tasks CARTON POURING SPHERICAL (CARTON) Fill the cartn with 200ml f water. Place the glass jar (withut the lid) n the designated left area. Place the cartn in the designated area n the SHAP bard with the sput f the cartn pinting tward t glass jar. Ensure the timer is in its slt n the SHAP bard and the bjects starting psitin is aligned with the participant s dminant hand. Start the timer and whilst ensuring as little spillage as pssible, pur the water frm the cartn int the jar as demnstrated and as quickly as pssible. Replace the cartn n the bard and then stp the timer. [Pick up the cartn using a spherical grip and shw hw t pur the water int the glass jar then reset the task fr the participant. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] 22

23 BUTTON BOARD TRIPOD (BUTTON) Place the buttn bard t the right f the timer unit. The buttns shuld be farthest frm the timer unit. Ensure the timer is in its slt n the SHAP bard and the bjects starting psitin is aligned with the participant s dminant hand. Start the timer and using nly the apprpriate hand, und all fur buttns in any rder as demnstrated and as quickly as pssible. Yu may steady the buttn bard with yur ther hand s that it remains n the SHAP bard thrughut the task. Then stp the timer using nly the apprpriate hand. [Und each buttn in turn, using nly the assessed hand in a tripd grip and reset the task fr the participant. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] LIFTING A HEAVY OBJECT POWER (HEAVY) Fill the glass jar with water t the tp f the label and tighten the lid. Place the jar in the designated left area n the SHAP bard. Place the empty cartn lengthways alng the middle f the SHAP bard (withut bstructing the timer unit) t create a barrier. Ensure the timer is in its slt n the SHAP bard and the bjects starting psitin is aligned with the participant s dminant hand. Start the timer, mve the jar ver the cartn t the ther side f the bard as demnstrated and as quickly as pssible. Then stp the timer. [Lift the jar ver the cartn using a pwer grip and place n the ppsite side f the frm bard in the designated area. Reset the task fr the participant. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] LIFTING A LIGHT OBJECT POWER (LIGHT) Place the empty tin (with the plastic lid n) in the designated left area. Place the cartn n its side in its designated area as a barrier. Ensure the timer is in its slt n the SHAP bard and the bjects starting psitin is aligned with the participant s dminant hand. Start the timer, mve the tin ver the cartn t the ther side f the bard as demnstrated and as quickly as pssible. Then stp the timer. [Lift the tin ver the cartn using the pwer grip and place n the ppsite side f the SHAP bard in the designated area, then reset the task fr the participant. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] 23

24 GLASS JUG POURING LATERAL (JUG) Fill the glass jug with 100ml f water. Place the jug in the designated area f the SHAP bard with the handle f the glass jug pinting the right. Place the glass jar (withut the lid) n the designated left area. Ensure the timer is in its slt n the SHAP bard and the bjects starting psitin is aligned with the participant s dminant hand. Start the timer and whilst ensuring as little spillage as pssible, pur the water frm the jug int the jar as demnstrated and as quickly as pssible. Replace the jug n the bard and then stp the timer. [Lift the glass jug by the handle using a lateral grip and shw hw t pur the water int the glass jar. Reset the task fr the participant. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] PAGE TURNING EXTENSION (PAGE) Place the piece f card in the designated area n the ppsite side f the platfrm t the hand under assessment. Ensure the timer is in its slt n the SHAP bard. Start the timer lift and turn ver the card as if yu were turning the pages f a bk and place the card n the ppsite side f the bard as demnstrated and as quickly as pssible. Then stp the timer. [Using an extensin grip, pick up the card, turn it ver as if turning the pages f a bk and place it n the ppsite side f the SHAP bard. Reset the task fr the participant. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] Case tasks ROTATE A SCREW POWER (SCREW) Place the screwdriver in the designated area n the bard n the right side. The arrw unit is munted n a clip, which shuld be attached t the frnt f the case. Use the area directly in frnt f the screwdriver between the lck and the handle n the case. Ensure the arrw is pinting upward. Ensure the timer is in its slt n the SHAP bard and the bjects starting psitin is aligned with the participant s dminant hand. Start the timer and use the screwdriver t rtate the screw a quarter turn clckwise t, r beynd the white mark as demnstrated and as quickly as pssible. Once cmpleted, the screwdriver shuld be replaced n the platfrm and the timer stpped. Tw hands may be used t guide the screwdriver t the screw, but nly the apprpriate hand shuld be used fr turning the screw. Yur ther hand can be used t steady the tp f the arrw unit. [Demnstrate the task using a pwer grip. Reset the task fr the participant. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] 24

25 DOOR HANDLE POWER (HANDLE) Ensure the timer is in its slt n the SHAP bard and the bjects starting psitin is aligned with the participant s dminant hand. Start the timer, rtate the dr handle until it is fully pen and then release it as demnstrated and as quickly as pssible. Then stp the timer. [Rtate the dr handle using a pwer grip until it is fully pen, and then release the handle. Reset the task fr the participant. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] ROTATE KEY TIP (KEY) Place the bard in the case ADL side up n tp f the fam insert (the timer unit shuld fit neatly in its riginal psitin n the bard withut mving it frm the fam). Ensure the key is aligned with the participant s dminant hand. Start the timer, rtate the key as demnstrated and as quickly as pssible t the white mark and release the key (at which time the key will spring back t its start psitin) and then stp the timer. [Turn the key t the white mark using the tip grip. Reset the task fr the participant. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] OPEN/CLOSE ZIP LATERAL/TIP (ZIP) Ensure the zip is clsed. Ensure the timer is in its slt n the SHAP bard and the bjects starting psitin is aligned with the participant s dminant hand. Start the timer, pen and clse the zip as demnstrated and as quickly as pssible and then stp the timer. [Open and clse the zip using a lateral r tip grip. Start timer fr 1 minute t enfrce practice time limit. Recrd the participant s time.] 25

26 Table S1 - mshap Results Subject 1 Succesful cmpletin times (s) fr each task f the mshap fr each sessin fr Subject 1. DNF recrded fr unsuccessful attempts Tasks Sessin 1 Sessin 2 Sessin 3 Sessin 4 Sessin 5 Sessin 6 Sessin 7 Sessin 8 Sessin 9 Sessin 10 Light Spherical Light Tripd Light Pwer Light Lateral DNF Light Tip Light Extensin Heavy Spherical DNF Heavy Tripd Heavy Pwer Heavy Lateral Heavy Tip Heavy Extensin Cartn Buttn Heavy Light Screw DNF Handle Jug Key DNF Zip Page

27 Table S2 - mshap Results Subject 2 Succesful cmpletin times (s) fr each task f the mshap fr each sessin fr Subject 2. DNF recrded fr unsuccessful attempts Tasks Sessin 1 Sessin 2 Sessin 3 Sessin 4 Sessin 5 Sessin 6 Sessin 7 Sessin 8 Sessin 9 Sessin 10 Light Spherical Light Tripd Light Pwer Light Lateral Light Tip DNF Light Extensin Heavy Spherical DNF Heavy Tripd DNF Heavy Pwer Heavy Lateral Heavy Tip Heavy Extensin Cartn Buttn Heavy Light Screw Handle Jug Key Zip Page DNF

28 Table S3 - mshap Results Subject 3 Succesful cmpletin times (s) fr each task f the mshap fr each sessin fr Subject 3. DNF recrded fr unsuccessful attempts Tasks Sessin 1 Sessin 2 Sessin 3 Sessin 4 Sessin 5 Sessin 6 Sessin 7 Sessin 8 Sessin 9 Sessin 10 Light Spherical Light Tripd Light Pwer Light Lateral Light Tip Light Extensin Heavy Spherical Heavy Tripd Heavy Pwer Heavy Lateral Heavy Tip Heavy Extensin Cartn Buttn Heavy Light Screw DNF DNF Handle Jug Key Zip Page

29 Table S4 - mshap Results Subject 4 Succesful cmpletin times (s) fr each task f the mshap fr each sessin fr Subject 4. DNF recrded fr unsuccessful attempts Tasks Sessin 1 Sessin 2 Sessin 3 Sessin 4 Sessin 5 Sessin 6 Sessin 7 Sessin 8 Sessin 9 Sessin 10 Light Spherical Light Tripd DNF Light Pwer Light Lateral Light Tip Light Extensin DNF Heavy Spherical DNF 3.6 Heavy Tripd Heavy Pwer Heavy Lateral Heavy Tip Heavy Extensin Cartn DNF Buttn Heavy Light Screw DNF Handle Jug Key Zip Page

30 Table S5 - mshap Results Subject 5 Succesful cmpletin times (s) fr each task f the mshap fr each sessin fr Subject 5. DNF recrded fr unsuccessful attempts Tasks Sessin 1 Sessin 2 Sessin 3 Sessin 4 Sessin 5 Sessin 6 Sessin 7 Sessin 8 Sessin 9 Sessin 10 Light Spherical Light Tripd DNF Light Pwer Light Lateral Light Tip Light Extensin Heavy Spherical Heavy Tripd Heavy Pwer Heavy Lateral 7.65 DNF Heavy Tip DNF Heavy Extensin Cartn DNF Buttn Heavy Light Screw DNF Handle Jug DNF Key Zip DNF Page