To Örebro University

Aims and objectives: Myoelectric prostheses can be prescribed to people born with upper limb reduction deficiency or with acquired amputation in order to improve their function and quality of life. Despite this, prostheses are used in varying degrees. An environment with barriers, or without facilitators, will restrict the individual’s occupational performance and can also result in limitations of Quality of Life. According to the International Classification of Functioning, disability and health (ICF) the environment includes the physical, social and attitudinal environment in which people live and conduct their lives. Few studies have been made to see the impact of environmental factors on prosthesis use. In this study the ICF- model is the framework to understand the complexity of environmental factors influence on prostheses use. The aim of this study was to describe users’ experience of how environmental factors influence their use of a myoelectric prosthesis in both congenital and acquired absence of a hand.

Method: Qualitative descriptive approach. Semi-structured interviews were audiotaped, transcribed by the first author and analyzed through inductive content analysis according to Graneheim & Lundman. Investigator triangulation was used to ensure the credibility.

Subjects: Strategic selection was used to get a varied sample in terms of sex, age, deficiency level, etiology, current prosthesis use, and length of experience. Interviews were conducted with 13 adult patients, previously provided with a myoelectric prosthetic hand at the Prosthetics and Orthotics Outpatient Clinic in Örebro, Sweden. The participants were 9 males and 4 females with age ranging from 20-74 years; they had acquired (n=5) or congenital (n=8) cause of absence at trans-humeral (n=3) or trans-radial (n=10) level. Their experience from prosthesis use was ranging from 2- 30 years. At the time of data collection the participants reported different patterns of prosthesis use: daily (n= 6) or non-daily (n=7), ranging from use only at work to never.

Results: The overarching theme “Different degree of embodiment provides various experiences ofinfluence from environment” illustrates the participants’ adaptation to prosthesis, which in turn influences the ability to manage environmental barriers. Four categories emerged from the data, “The prosthesis function”, “Other peoples’ attitudes”, “Support from family and healthcare” and “Personal approach to the environment”. Environmental facilitators such as, support from family and healthcare, and, good function and fit of the prosthesis, helped to make the prosthesis an embodied experience, leading to daily use. This embodiment reduces the influence of environmental barriers, e.g. climate, attitudes, and technical shortcomings. Myoelectric prosthesis use facilitates activity and participation among daily users.

Conclusions: The embodiment of the prosthesis may reduce influence of environmental barriers and promote myoelectric prosthesis use in both congenital and acquired upper limb deficiency. The users’ experience in this study indicates that support and training can facilitate the embodiment of myoelectric prosthesis. Thus, as prescribers of prostheses it is our responsibility to give support and information to the patient and also to family, pre-school and school teachers, and local healthcare, in order to motivate and encourage prosthesis use in everyday life.