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  • 1.
    Lendaro, Eva
    et al.
    Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Goteborg, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics.
    Burger, Helena
    University Rehabilitation Institute, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
    van der Sluis, Corry K
    Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
    McGuire, Brian E.
    School of Psychology & Centre for Pain Research, National University of Ireland, Galway, Ireland.
    Pilch, Monika
    School of Psychology & Centre for Pain Research, National University of Ireland, Galway, Ireland.
    Bunketorp-Käll, Lina
    Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Kulbacka-Ortiz, Katarzyna
    Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rignér, Ingrid
    Gåskolan/Ortopedteknik, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
    Stockselius, Anita
    Rehabcenter Sfären, Bräcke Diakoni, Stockholm, Sweden.
    Widehammar, Cathrine
    Örebro University, School of Health Sciences.
    Hill, Wendy
    Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick, Canada.
    Geers, Sybille
    Fysische Geneeskunde en Revalidatie, University Hospital Gent, Gent, Belgium.
    Ortiz-Catalan, Max
    Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Göteborg, Sweden; Integrum AB, Mölndal, Sweden.
    Phantom motor execution as a treatment for phantom limb pain: protocol of an international, double-blind, randomised controlled clinical trial2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 7, article id e021039Article in journal (Refereed)
    Abstract [en]

    Introduction: Phantom limb pain (PLP) is a chronic condition that can greatly diminish quality of life. Control over the phantom limb and exercise of such control have been hypothesised to reverse maladaptive brain changes correlated to PLP. Preliminary investigations have shown that decoding motor volition using myoelectric pattern recognition, while providing real-time feedback via virtual and augmented reality (VR-AR), facilitates phantom motor execution (PME) and reduces PLP. Here we present the study protocol for an international (seven countries), multicentre (nine clinics), double-blind, randomised controlled clinical trial to assess the effectiveness of PME in alleviating PLP.

    Methods and analysis: Sixty-seven subjects suffering from PLP in upper or lower limbs are randomly assigned to PME or phantom motor imagery (PMI) interventions. Subjects allocated to either treatment receive 15 interventions and are exposed to the same VR-AR environments using the same device. The only difference between interventions is whether phantom movements are actually performed (PME) or just imagined (PMI). Complete evaluations are conducted at baseline and at intervention completion, as well as 1, 3 and 6 months later using an intention-to-treat (ITT) approach. Changes in PLP measured using the Pain Rating Index between the first and last session are the primary measure of efficacy. Secondary outcomes include: frequency, duration, quality of pain, intrusion of pain in activities of daily living and sleep, disability associated to pain, pain self-efficacy, frequency of depressed mood, presence of catastrophising thinking, health-related quality of life and clinically significant change as patient’s own impression. Follow-up interviews are conducted up to 6 months after the treatment.

    Ethics and dissemination: The study is performed in agreement with the Declaration of Helsinki and under approval by the governing ethical committees of each participating clinic. The results will be published according to the Consolidated Standards of Reporting Trials guidelines in a peer-reviewed journal.

    Trial registration number: NCT03112928; Pre-results.

  • 2.
    Lendaro, Eva
    et al.
    Chalmers University Of Technology, Gothenburg, Sweden.
    Hermansson, Liselotte
    Örebro University Hospital, Örebro, Sweden.
    Burger, Helena
    University Rehabilitation Institute, Ljubljana, Slovenia.
    van der Sluis, Corry
    University Medical Centre Groningen, Groningen, Netherlands.
    McGuire, Brian E.
    National University of Ireland, Ireland.
    Pilch, Monika
    National University of Ireland, Ireland.
    Bunketorp-Käll, Lina
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Kulbacka-Ortiz, Katarzyna
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rignér, Ingrid
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Stockselius, Anita
    Rehabcenter Sfären, Bräcke Diakoni, Stockholm, Sweden.
    Gudmundson, Lena
    Rehabcenter Sfären, Bräcke Diakoni, Stockholm, Sweden.
    Widehammar, Cathrine
    Örebro University Hospital, Örebro, Sweden.
    Hill, Wendy
    University of New Brunswick, New Brunswick, Canada.
    Geers, Sybille
    University Hospital Gent, Gent, Belgium.
    Diers, Martin
    Ruhr University Bochum, Bochum, Germany.
    Catalan, Max Ortiz
    Chalmers University Of Technology, Gothenburg, Sweden.
    Phantom Motor Execution as a treatment for Phantom Limb Pain: Protocol of an international, double-blind, randomised, controlled clinical trial2018In: Book of Abstracts / [ed] Burger, Helena & Mlakar, Maja, Ljubljana, Slovenien: ISPO Slovenaia , 2018, p. 14-14Conference paper (Refereed)
  • 3.
    Ortiz-Catalan, Max
    et al.
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden; Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden; Integrum AB, Mölndal, Sweden.
    Gudmundsdottir, Rannveig A.
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden; Integrum AB, Mölndal, Sweden.
    Kristoffersen, Morten B.
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden; Integrum AB, Mölndal, Sweden.
    Zepeda-Echavarria, Alejandra
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden; Integrum AB, Mölndal, Sweden.
    Caine-Winterberger, Kerstin
    Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden.
    Kulbacka-Ortiz, Katarzyna
    Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden.
    Widehammar, Cathrine
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden; Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Eriksson, Karin
    Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Stockselius, Anita
    Bräcke Diakoni Rehabcenter Sfären, Solna, Sweden.
    Ragnö, Christina
    Bräcke Diakoni Rehabcenter Sfären, Solna, Sweden.
    Pihlar, Zdenka
    University Rehabilitation Institute, Ljubljana, Slovenia.
    Burger, Helena
    University Rehabilitation Institute, Ljubljana, Slovenia.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden; Department of Prosthetics and Orthotics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Phantom motor execution facilitated by machine learning and augmented reality as treatment for phantom limb pain: a single group, clinical trial in patients with chronic intractable phantom limb pain2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10062, p. 2885-2894Article in journal (Refereed)
    Abstract [en]

    Background: Phantom limb pain is a debilitating condition for which no eff ective treatment has been found. We hypothesised that re-engagement of central and peripheral circuitry involved in motor execution could reduce phantom limb pain via competitive plasticity and reversal of cortical reorganisation.

    Methods: Patients with upper limb amputation and known chronic intractable phantom limb pain were recruited at three clinics in Sweden and one in Slovenia. Patients received 12 sessions of phantom motor execution using machine learning, augmented and virtual reality, and serious gaming. Changes in intensity, frequency, duration, quality, and intrusion of phantom limb pain were assessed by the use of the numeric rating scale, the pain rating index, the weighted pain distribution scale, and a study-specifi c frequency scale before each session and at follow-up interviews 1, 3, and 6 months after the last session. Changes in medication and prostheses were also monitored. Results are reported using descriptive statistics and analysed by non-parametric tests. The trial is registered at ClinicalTrials. gov, number NCT02281539.

    Findings: Between Sept 15, 2014, and April 10, 2015, 14 patients with intractable chronic phantom limb pain, for whom conventional treatments failed, were enrolled. After 12 sessions, patients showed statistically and clinically signifi cant improvements in all metrics of phantom limb pain. Phantom limb pain decreased from pre-treatment to the last treatment session by 47% (SD 39; absolute mean change 1 . 0 [0 . 8]; p= 0 . 001) for weighted pain distribution, 32% (38; absolute mean change 1 . 6 [1 . 8]; p= 0 . 007) for the numeric rating scale, and 51% (33; absolute mean change 9 . 6 [8 . 1]; p= 0 . 0001) for the pain rating index. The numeric rating scale score for intrusion of phantom limb pain in activities of daily living and sleep was reduced by 43% (SD 37; absolute mean change 2 . 4 [2 . 3]; p= 0 . 004) and 61% (39; absolute mean change 2 . 3 [1 . 8]; p= 0 . 001), respectively. Two of four patients who were on medication reduced their intake by 81% (absolute reduction 1300 mg, gabapentin) and 33% (absolute reduction 75 mg, pregabalin). Improvements remained 6 months after the last treatment.

    Interpretation: Our fi ndings suggest potential value in motor execution of the phantom limb as a treatment for phantom limb pain. Promotion of phantom motor execution aided by machine learning, augmented and virtual reality, and gaming is a non-invasive, non-pharmacological, and engaging treatment with no identifi ed side-eff ects at present.

  • 4.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences. Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Eriksson, Karin
    Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. 2University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Designing a new training method for advanced hand prostheses2018In: Book of Abstracts, Ljubljana, Slovenia: ISPO Slovenia , 2018, p. 66-66Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION: New prosthetic hands with advanced technology making it possible to perform many different grasps and positions are now available on the market. This new advanced technology is also difficult for users to control, and studies have shown that the new hand functions are not used to the extent expected (1).

    The Örebro Centre for Limb Deficiency and Arm Prostheses has a long experience of prosthetic fitting for both children and adults. About 80% of the adults report daily prosthesis use (2). Today, many prosthesis users find the advanced prosthetic hands interesting and wish to have one. However, when introducing a new prosthetic hand with questionable merits, the reasons for these results need to be considered. In light of our experience from fittings in Örebro, we decided that the training programs for the new hand models were not comprehensive enough, and there was a need for the development of a new method for training.

    AIMS: To design a training method for advanced hand prosthetic hands.

    METHODS: We performed a review of existing training programs for advanced myoelectric prosthetic hands and combined this with a structured training program, and a treatment philosophy with early fitting and regular follow up used in Örebro.

    RESULTS AND CONCLUSIONS: The training method comprises control training and performance of ADL’s. It follows a structured program based on the 14 steps described in the Skills Index Ranking Scale. The control training focuses on control of all different grasps available with the body in different positions: sitting, standing; with and without support of the arm. The ADL’s are chosen individually through a Canadian Occupational Performance Measure interview. The capacity to use different grasps and integrating the new prosthesis when performing ADL’s is evaluated through the Assessment of Capacity for Myoelectric Control. The method is based on regular support and feedback from an occupational therapist, with follow-ups weekly the first month and then monthly the following 3-6 months. The method has been used on patients with good results.

    CONCLUSION: A new method is designed to fit the new multifunctional prosthetic hands. The method can be applied upon prescription of advanced multifunctional prosthetic hands to enhance the functional use of the hands.

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    Designing a new training method for advanced hand prostheses
  • 5.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden ; Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lidström, Helene
    Department of Social and Welfare Studies, Faculty of Medicine, Linköping University, Linköping, Sweden.
    Use of myoelectric prostheses and participation in everyday activities: environmental factors impact on assistive technology use2016In: “Advances in our Understanding”: The Compendium, 2016, p. 61-61Conference paper (Other academic)
  • 6.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Pettersson, Ingvor
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Janeslätt, Gunnel
    Experiences of myoelectric arm prosthesis users: the influence of environment: Influence of environment on myoelectric prosthesis useManuscript (preprint) (Other academic)
  • 7.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences. Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Lidström, Helene
    Department of Social and Welfare Studies, Faculty of Medicine, Linköping University, Linköping, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Environmental barriers to participation and facilitators for use of three types of assistive technology devices2017In: MEC 2017 - A Sense of What´s to Come: Myoelectric Controls and Upper Limb Prosthetics Symposium, Fredericton, New Brunswick, Canada: University of New Brunswick , 2017, p. 36-36Conference paper (Refereed)
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    Environmental barriers to participation and facilitators for use of three types of assistive technology devices
  • 8.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences. Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Lidström, Helene
    Department of Social and Welfare Studies, Faculty of Medicine, Linköping University, Linköping, Sweden.
    Hermansson, Liselotte
    Örebro University Hospital. Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Environmental barriers to participation and facilitators for use of three types of assistive technology devices2017In: Nobelday Festivities Orebro University, 2017Conference paper (Refereed)
    Abstract [en]

    Background: In rehabilitation, assistive technology (AT) is prescribed in order to improve activity and participation for individuals with disability. Research shows that many devices are not used to the extent or to the benefits expected. The aim of this study was to compare the presence of environmental barriers to participation and facilitators for AT use and study the relation between barriers and AT use in three different types of AT devices.

    Methods: A cross-sectional survey was conducted. Inclusion criteria were: ≥1 year experience as user of myoelectric prosthesis (MEP), powered mobility device (PMD), or assistive technology for cognition (ATC) and age 20-90 years. The survey contained the Swedish version of Craig Hospital Inventory of Environmental Factors and a study-specific questionnaire focusing on facilitating factors. Overall, 156 participants answered the survey. Non-parametric tests were used for comparisons.

    Results: Barriers to participation were significantly lowest in MEP users (md=0.12; p<0.001), and highest in ATC users (md=1.56; p<0.001-p=0.048). A positive correlation between fewer barriers and higher use of MEP was seen (r=0.30, p=0.038). Compared to the other groups, users of ATC with more use reported more barriers for participation. The greatest barriers to participation were: Natural environment, Surroundings, and, Information. Most support came from Relatives and Professionals.

    Conclusions: There is a difference in how users of different AT devices experience the environment in terms of barriers for participation and facilitators for use. The environment may facilitate AT use but barriers in the environment can still restrict participation in AT users. Future research should comprise the influence of AT use on participation.

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    Environmental barriers to participation and facilitators for use of three types of assistive technology devices
  • 9.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences. Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Lidström, Helene
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden; Department of Prosthetics and Orthotics , Örebro University , Örebro , Sweden.
    Environmental barriers to participation and facilitators for use of three types of assistive technology devices2019In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614, Vol. 31, no 2, p. 68-76Article in journal (Refereed)
    Abstract [en]

    The aim was to compare the presence of environmental barriers to participation and facilitators for assistive technology (AT) use and study the relation between barriers and AT use in three different AT devices. A cross-sectional survey was conducted. Inclusion criteria were ?one year of experience as a user of myoelectric prosthesis (MEP), powered mobility device (PMD), or assistive technology for cognition (ATC) and age 20-90 years. Overall, 156 participants answered the Swedish version of the Craig Hospital Inventory of Environmental Factors and a study-specific questionnaire on facilitating factors. Non-parametric tests were used for comparisons. Barriers to participation were lowest in MEP users (md = 0.12; p < 0.001), and highest in ATC users (md = 1.56; p < 0.001) with the least support for AT use (p < 0.001 - p = 0.048). A positive correlation between fewer barriers and higher use of MEP was seen (r = 0.30, p = 0.038). The greatest barriers to participation were Natural environment, Surroundings and Information, and the most support came from Relatives and Professionals. Support, training and education are vital in the use of AT. These factors may lead to a more sustained and prolonged use of AT and may enable increased participation. Future research should focus on interventions that meet the needs of people with cognitive disabilities.

  • 10.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences.
    Lidström, Helene
    Linköpings Universitet, Linköping, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences.
    Use of assistive technology and barriers for participation in everyday activities: environmental influence on use of three types of assistive technology devices2017Conference paper (Refereed)
  • 11.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences. Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre.
    Pettersson, Ingvor
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Attitudes is the most important environmental factor for use of powered mobility devices - users' perspectives2019In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Article in journal (Refereed)
    Abstract [en]

    Introduction: Different factors in the environment influence the use of powered wheelchairs or powered scooters, i.e. powered mobility devices (PMDs), but there is limited knowledge about how these factors interact and if any factor has a greater impact. According to the ICF the environment consists of five areas.

    Aim: To describe users' experiences of how environmental factors from all ICF areas influence the use of PMDs.

    Methods: Descriptive qualitative design including 14 interviews with PMD users, analyzed using inductive qualitative content analysis.

    Findings: Use of PMDs means a conditional freedom depending on the interaction of several environmental factors. Regardless of environmental factor the societal attitudes were always present, directly or indirectly, and influenced the participants' feeling of being included and involved in society. The environmental factors and how they influence PMD use are described in four categories, comprising the following subjects: societal attitudes, the service delivery process, accessibility to the physical environment and financial resources.

    Conclusion: The findings show that societal attitudes influence all other factors, directly by others people's attitudes, or indirectly by how legislation and guidelines are formulated, interpreted and applied. Therefore, a change of societal attitudes seems necessary to increase accessibility and participation for PMD users.

  • 12.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Pettersson, Ingvor
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The influence of environment: experiences from users of myoelectric arm prostheses2014In: MEC'14: Redefinig the Norm, Frederiction, New Brunswick, Canada: University of New Brunswick, Fredericton, Canada , 2014Conference paper (Refereed)
    Abstract [en]

    Background: Myoelectric prostheses are used in varying degrees. 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. An environment with barriers, or without facilitators, will restrict the individual’s occupational performance and can result in limitations of Quality of Life. 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 the experience of how environmental factors affect the use of myoelectric arm prostheses..                        

    Method: A qualitative descriptive approach was used and interviews were conducted with 13 adult prosthesis users 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. Qualitative content analysis with an inductive approach was used for data analysis.        

    Results: Participants’ experiences of prosthesis use and how environmental factors affect them could be divided into seven categories: Various adaptations to the environment; Other peoples attitudes affect use; Support promotes use; Technical shortcomings affect use; Climate affects comfort and function; Ignorance and legislation complicates; Different approach to usability. Two themes occurred in all the categories and gave an overall perspective of what the participants believe have an important impact on prosthesis use: The prosthesis is/is not a part of my body; and, It is important to be like everyone else. A model was created to clarify the relation between environmental factors and prosthesis use/non-use. It illustrates how a persons coping strategy interacts with all the different environmental factors it is exposed to and how this leads to usability in different degrees. The prosthesis use can be a barrier or a facilitator for activity, participation and body structure.  

    Conclusions: Embodiment of prosthesis reduces environmental barriers and facilitates future use in both congenital and acquired upper limb amputees. Support to the persons and their family in prosthetic use, access to prosthesis training close to home, and considerations taken to the prosthesis appearance and function will facilitate future prosthesis use.

  • 13.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences. Department of Pediatrics, Department of Prosthetics and Orthotics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Pettersson, Ingvor
    Örebro University, School of Health Sciences.
    Janeslätt, Gunnel
    Center for Clinical Research Dalarna, Falun, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    The influence of environment: experiences of users of myoelectric arm prosthesis - a qualitative study2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 1, p. 28-36Article in journal (Refereed)
    Abstract [en]

    Background: Prostheses are used to varying degrees; however, little is known about how environmental aspects influence this use.

    Objectives: To describe users" experiences of how environmental factors influence their use of a myoelectric arm prosthesis.

    Study design: Qualitative and descriptive.

    Methods: A total of 13 patients previously provided with a myoelectric prosthetic hand participated. Their age, sex, deficiency level, etiology, current prosthesis use, and experience varied. Semi-structured interviews were audiotaped, transcribed, and analyzed through inductive content analysis.

    Results: Four categories were created from the data: "Prosthesis function," "Other people's attitudes," "Support from family and healthcare," and "Individual's attitude and strategies." The overarching theme, "Various degrees of embodiment lead to different experiences of environmental barriers and facilitators," emerged from differences in individual responses depending on whether the individual was a daily or a non-daily prosthesis user. Environmental facilitators such as support from family and healthcare and good function and fit of the prosthesis seemed to help the embodiment of the prosthesis, leading to daily use. This embodiment seemed to reduce the influence of environmental barriers, for example, climate, attitudes, and technical shortcomings.

    Conclusion: Embodiment of prostheses seems to reduce the impact of environmental barriers. Support and training may facilitate the embodiment of myoelectric prosthesis use.

    Clinical relevance: For successful prosthetic rehabilitation, environmental factors such as support and information to the patient and their social network about the benefits of prosthesis use are important. Local access to training in myoelectric control gives more people the opportunity to adapt to prosthesis use and experience less environmental barriers.

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    The influence of environment
  • 14.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Region Örebro County, Örebro, Sweden; Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Pettersson, Ingvor
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Janeslätt, Gunnel
    Centre for Clinical Research Dalarna (CKF-Dalarna), Falun, Sweden; Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    The influence of environment: experiences of users of myoelectric arm prosthesis, a qualitative study2016In: “Advances in our Understanding”: The Compendium, 2016, p. 56-56Conference paper (Other academic)
    Abstract [en]

    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.

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