Author ORCID Identifier
0000-0002-6162-5827
Defense Date
2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Physical Therapy
First Advisor
Benjamin J Darter
Second Advisor
Sheryl Finucane
Third Advisor
Cody L McDonald
Fourth Advisor
Kirk W Brown
Fifth Advisor
Joseph B Webster
Abstract
The human hand is a powerful tool essential for performing a range of tasks from simple to complex, and it plays a crucial role in social interactions and environmental engagement. Upper limb (UL) loss disrupts these functions and significantly impacts daily life. Prosthetic devices can partially restore these abilities and improve quality of life, but they lack the intuitive control and sensory feedback of natural hands. Consequently, operating a UL prosthesis requires substantial attentional demands, a factor that potentially contributes to high rates of device dissatisfaction and disuse. For UL prosthesis users, managing attentional resources is critical to efficiently controlling their prosthetic devices. Despite its significance, the attentional demands of using a prosthesis are not well understood, nor is there sufficient insight into how these demands affect prosthesis control and rehabilitation.
Current assessments of attentional demands include both performance-based and patient-reported outcome (PRO) measures, with PRO measures personal experiences are incorporated into the items, which are crucial for clinicians to comprehend how users perceive their prostheses. However, existing tools are inadequate for UL prosthesis users, as they either do not apply to UL usage or lack psychometric rigor. To address this gap, this dissertation aimed to enhance an understanding of the prosthetic attention construct and develop candidate items through data collected from prosthesis users and clinical rehabilitation experts who treat those with limb loss.
Chapter 2 utilized focus group discussions with 25 UL prosthesis users of various levels of limb loss and experiences, and explored how users conceptualize prosthetic attention. The qualitative analysis from this chapter highlights thematic connections related to the reasons for paying attention, factors influencing the amount of attention, and the results of paying attention. UL prosthesis users also described various scenarios and activities where prosthetic attention helped them complete the task successfully, whereas some users described the negative consequences, such as frustration, related to prosthetic attention. Overall, the findings of this study guided the conceptualization of prosthetic attention in UL users.
Chapter 3 focused on developing candidate items to measure prosthetic attention. Using insights from a thorough literature review and the findings from Chapter 2, a comprehensive list of candidate items was generated describing different scenarios and activities where prosthetic attention was experienced by the users. A total of 844 candidate items were assessed and refined by the research team and two rounds of cognitive interviews conducted with 33 users of varying levels of experience with UL prosthesis use. The feedback from these interviews resulted in a final set of 77 candidate items appropriate for further testing in a large-scale survey.
Chapter 4 investigated how clinicians perceive and incorporate prosthetic attention in their practice while working with UL and lower limb users. Through semi-structured interviews conducted with 15 physical and occupational therapists, this chapter identified three main themes that highlight the importance of prosthetic attention, especially during initial stages of prosthesis use. This chapter also emphasized the current lack of outcome measures to evaluate this construct in clinical settings.
Together, these chapters provide crucial insights into the use of prosthetic devices among individuals with UL loss and underscore the need for subjective assessments to understand and improve prosthetic attention. The development of an item bank specific for measuring prosthetic attention has the potential to significantly enhance clinical decision-making and rehabilitation practices for UL prosthesis users.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
8-14-2024
Included in
Kinesiotherapy Commons, Movement and Mind-Body Therapies Commons, Occupational Therapy Commons, Orthotics and Prosthetics Commons, Other Rehabilitation and Therapy Commons, Physical Therapy Commons, Physiotherapy Commons, Somatic Bodywork and Related Therapeutic Practices Commons, Translational Medical Research Commons