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Cost-Effectiveness Of High-Intensity Training Vs Conventional Therapy For Individuals With Subacute Stroke, T. George Hornby, Miriam Rafferty, Daniel Pinto, Dustin D. French, Neil Jordan

Physical Therapy Faculty Research and Publications

Objective

This investigation estimated the incremental cost-effectiveness of high-intensity training (HIT) compared with conventional physical therapy in individuals with subacute stroke, based on the additional personnel required to deliver the therapy.

Design

Secondary analysis from a pilot study and subsequent randomized controlled trial.

Setting

Outpatient laboratory setting.

Participants

Data were collected from individuals with locomotor impairments 1-6 months poststroke (N=44) who participated in HIT (n=27) or conventional physical therapy (n=17).

Interventions

Individuals performing HIT practiced walking tasks in variable contexts (stairs, overground, treadmill) while targeting up to 80% maximum heart rate reserve. Individuals performing conventional therapy practiced impairment-based and functional …

The Value Of High Intensity Locomotor Training Applied To Patients With Acute-Onset Neurologic Injury, Meghan Fahey, Gabrielle Brazg, Christopher E. Henderson, Abby Plawecki, Emily H. Lucas, Darcy S. Reisman, Brian D. Schmit, T. George Hornby

Biomedical Engineering Faculty Research and Publications

The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can …

Total Knee Arthroplasty Assessments Should Include Strength And Performance-Based Functional Tests To Complement Range-Of-Motion And Patient-Reported Outcome Measures, Jacob J. Capin, Michael J. Bade, Jason M. Jennings, Lynn Snyder-Mackler, Jennifer E. Stevens-Lapsley

Physical Therapy Faculty Research and Publications

Range of motion (ROM) and pain often define successful recovery after total knee arthroplasty (TKA), but these routine clinical outcomes correlate poorly or not at all to functional capacity after TKA. The purpose of this Perspective is to underscore the importance of muscle strength and performance-based functional tests in addition to knee ROM and patient-reported outcome (PRO) measures to evaluate outcomes after TKA. Specifically: (1) muscle strength is the rate-limiting step for recovery of function after TKA; (2) progressive rehabilitation targeting early quadriceps muscle strengthening improves outcomes and does not compromise ROM after TKA; (3) ROM and PROs fail to …

Predicting Duration Of Outpatient Physical Therapy Episodes For Individuals With Spinal Cord Injury Based On Locomotor Training Strategy, Mauricio Garnier-Villarreal, Daniel Pinto, Chaithanya K. Mummidisetty, Arun Jayaraman, Candy Tefertiller, Susan Charlifue, Heather B. Tayler, Shuo-Hsiu Chang, Nicholas Mccombs, Catherine L. Furbish, Edelle C. Field-Fote, Allen W. Heinemann

Physical Therapy Faculty Research and Publications

Objective

To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy.

Design

Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services.

Setting

Rehabilitation and community wellness facilities at 4 SCI Model Systems centers.

Participants

Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of …

Developing Peri-Operative Rehabilitation In Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 6]: An Unexplored Opportunity?, Timothy F. Boerger, Allison S. Hyngstrom, Julio C. Furlan, Sukhvinder Klasi-Ryan, Armin Curt, Brian K. Kwon, Shekar N. Kurpad, Michael G. Fehlings, James S. Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, James D. Guest, Jefferson R. Wilson, Benjamin M. Davies, Mark R. N. Kotter, Paul A. Koljonen

Physical Therapy Faculty Research and Publications

Study Design

Narrative review.

Objective

Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies.

Methods

Literature search.

Results

In other neurological disorders such as …

Task-Specific Versus Impairment-Based Training On Locomotor Performance In Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study, Jennifer K. Lotter, Christopher E. Henderson, Abby Plawecki, Molly E. Holthus, Emily H. Lucas, Marzieh M. Ardestani, Brian Schmit, George Hornby

Biomedical Engineering Faculty Research and Publications

Background. Many research studies attempting to improve locomotor function following motor incomplete spinal cord injury (iSCI) focus on providing stepping practice. However, observational studies of physical therapy strategies suggest the amount of stepping practice during clinical rehabilitation is limited; rather, many interventions focus on mitigating impairments underlying walking dysfunction. Objective. The purpose of this blinded-assessor randomized trial was to evaluate the effects of task-specific versus impairment-based interventions on walking outcomes in individuals with iSCI. Methods. Using a crossover design, ambulatory participants with iSCI >1-year duration performed either task-specific (upright stepping) or impairment-based training for up to 20 sessions over ≤6 …

Home-Based, Square-Stepping Exercise Program Among Older Adults With Multiple Sclerosis: Results Of A Feasibility Randomized Controlled Study, Emerson Sebastião, Edward Mcauley, Ryosuke Shigematsu, Brynn C. Adamson, Rachel Bollaert, Robert W. Motl

Exercise Science Faculty Research and Publications

There is very little known about exercise rehabilitation approaches for older adults with multiple sclerosis (MS), yet this growing segment of the MS population experiences declines in cognition and mobility associated with disease progression and aging. We conducted a RCT examining the feasibility of a 12-week, home-based Square-Stepping Exercise (SSE) program in older adults with MS. Older adults with MS (N = 26) with mild-to-moderate levels of disability were recruited and randomized into the intervention (i.e., SSE) or a minimal activity, attention-control conditions. Participants in the SSE condition received a mat for home-based practice of the step patterns, an …

Promoting Global Clinical Care And Research For Children With Orthopaedic Disabilities Through Motion Analysis Technology, Jacob R. Rammer, Joycie Eulah Abiera, Monica Arroyo, Luis Fernando Caicedo, Karl Canseco, Christopher Constantino, Filipe Haces Garcia, Jorge Gomez, Nikhil T. Kurapati, Mariano Gonzalez Lugo, Terence Miller, Wilfredo Agredo Rodriguez, Carlo Emmanuel Sumpaico, Gerald F. Harris

Biomedical Engineering Faculty Research and Publications

Human motion analysis is a tool used to understand orthopaedic disabilities in children and to plan and monitor treatment strategies. It enables clinicians to quantitatively describe rehabilitative progress, plan surgeries, and conduct research. While this technology is prevalent in major academic medical centers, access is lacking in many regions throughout the world. This paper presents a novel approach to offer more accessible technology at greatly reduced cost. Current applications are underway in the Philippines, Mexico, and Colombia. Through international partnerships, improvements in clinical care, medical education, and research have been observed.

Six-Minute Walk Test Performance In Persons With Multiple Sclerosis While Using Passive Or Powered Ankle-Foot Orthoses, Morgan K. Boes, Rachel Bollaert, Richard M. Kesler, Yvonne C. Learmonth, Mazharul Islam, Matthew N. Petrucci, Robert W. Motl, Elizabeth T. Hsiao-Wecksler

Exercise Science Faculty Research and Publications

Objective

To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS).

Design

Short-term intervention.

Setting

University research laboratory.

Participants

Participants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO.

Interventions

Three 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb.

Main Outcome Measures

Distance walked and metabolic cost of transport were recorded during each 6MWT and …

Association Between Sedentary Time And Quality Of Life From The Osteoarthritis Initiative: Who Might Benefit Most From Treatment?, Daniel Pinto, Jing Song, Jungwha Lee, Rowland W. Chang, Pamela A. Semanik, Linda S. Ehrlich-Jones, Christine A. Pellegrini, Dorothy D. Dunlop

Physical Therapy Faculty Research and Publications

Objective

To investigate the relationship between sedentary behavior and quality-adjusted life years (QALYs) among participants in the Osteoarthritis Initiative.

Design

Longitudinal, observational design.

Setting

Osteoarthritis Initiative cohort.

Participants

Individuals (N=1794) from a prospective, multicenter longitudinal cohort were classified into quantile groups based on average daily sedentary time (most sedentary, quartile 1 [Q1] ≥11.6h; 10.7h≤ Q2

Interventions

Not applicable.

Main Outcome Measures

Individual QALYs were estimated over 2 years from the area under the curve of health-related utility scores derived from the Medical Outcomes Study 12-Item Short-Form Health Survey versus time. The relationship between baseline sedentary behavior and median 2-year QALYs …

Robotic Resistance Treadmill Training Improves Locomotor Function In Children With Cerebral Palsy: A Randomized Controlled Pilot Study, Ming Wu, Janis Kim, Deborah J. Gaebler-Spira, Brian D. Schmit, Pooja Arora

Biomedical Engineering Faculty Research and Publications

Objective

To determine whether applying controlled resistance forces to the legs during the swing phase of gait may improve the efficacy of treadmill training as compared with applying controlled assistance forces in children with cerebral palsy (CP).

Design

Randomized controlled study.

Setting

Research unit of a rehabilitation hospital.

Participants

Children with spastic CP (N=23; mean age, 10.6y; range, 6–14y; Gross Motor Function Classification System levels, I–IV).

Interventions

Participants were randomly assigned to receive controlled assistance (n=11) or resistance (n=12) loads applied to the legs at the ankle. Participants underwent robotic treadmill training 3 times a week for 6 weeks (18 …

Reliability And Validity Of Ratings Of Perceived Exertion In Persons With Multiple Sclerosis, Brice T. Cleland, Benjamin A. Ingraham, Molly C. Pitluck, Alexander V. Ng

Exercise Science Faculty Research and Publications

Objective: To test the reliability and validity of using the Borg rating of perceived exertion (RPE) scale (ratings 6e20) in persons with multiple sclerosis (PwMS).

Design: Nonrandomized repeated measures.

Setting: Research laboratory.

Participants: Volunteer sample (N=27) comprised of 16 PwMS (10 women) and 11 age-matched persons without multiple sclerosis (MS) (6 women). Clinical measures included symptomatic fatigue, depression, and MS functional capacity.

Interventions: A submaximal cycling test was performed to estimate maximal capacity. Participants then pedaled for 2 minutes at 50% and 60% of predicted maximal oxygen consumption per unit time (V̇O₂), and physiological measures and RPE were …

Can A Home-Based Cardiac Physical Activity Program Improve The Physical Function Quality Of Life In Children With Fontan Circulation?, Roni M. Jacobsen, Salil Ginde, Kathleen Mussatto, Jennifer Neubauer, Michael G. Earing, Michael E. Danduran

Exercise Science Faculty Research and Publications

Objective

Patients after Fontan operation for complex congenital heart disease (CHD) have decreased exercise capacity and report reduced health-related quality of life (HRQOL). Studies suggest hospital-based cardiac physical activity programs can improve HRQOL and exercise capacity in patients with CHD; however, these programs have variable adherence rates. The impact of a home-based cardiac physical activity program in Fontan survivors is unclear. This pilot study evaluated the safety, feasibility, and benefits of an innovative home-based physical activity program on HRQOL in Fontan patients.

Methods

A total of 14 children, 8–12 years, with Fontan circulation enrolled in a 12-week moderate/high intensity home-based …

The Painful Long Head Of The Biceps Brachii: Nonoperative Treatment Approaches, Kevin E. Wilk, Todd R. Hooks

Physical Therapy Faculty Research and Publications

Pain associated with the long head of the biceps (LHB) brachii seems to be increasingly recognized in the past 4 to 5 years. The LHB has long been considered a troublesome pain generator in the shoulder. Abnormality involving the LHB brachii has long been an area of debate, with Codman in 1934 even questioning the specificity of the diagnosis of biceps tendinitis. Biceps tendon abnormality is often associated with rotator cuff impingement. Shoulder pain originating from the biceps tendon can be debilitating, causing a severe decrease in shoulder function. As a result of the frequent clinical presentation of biceps pain, …

Increased Lower Limb Spasticity But Not Strength Or Function Following A Single-Dose Serotonin Reuptake Inhibitor In Chronic Stroke, Krishnaj Gourab, Brian D. Schmit, T. George Hornby

Biomedical Engineering Faculty Research and Publications

Objective: To investigate the effects of single doses of a selective serotonin reuptake inhibitor (SSRI) on lower limb voluntary and reflex function in individuals with chronic stroke.

Design: Double-blind, randomized, placebo-controlled crossover trial.

Setting: Outpatient research setting.

Participants: Individuals (N=10; 7 men; mean age ± SD, 57±10y) with poststroke hemiplegia of >1 year duration who completed all assessments.

Interventions: Patients were assessed before and 5 hours after single-dose, overencapsulated 10-mg doses of escitalopram (SSRI) or placebo, with 1 week between conditions.

Main Outcome Measures: Primary assessments included maximal ankle and knee isometric strength, and velocity-dependent (30°/s–120°/s) plantarflexor stretch reflexes under …

A Novel Fmri Paradigm Suggests That Pedaling-Related Brain Activation Is Altered After Stroke, Nutta-On Promjunyakul, Brian D. Schmit, Sheila M. Schindler-Ivens

Physical Therapy Faculty Research and Publications

The purpose of this study was to examine the feasibility of using functional magnetic resonance imaging (fMRI) to measure pedaling-related brain activation in individuals with stroke and age-matched controls. We also sought to identify stroke-related changes in brain activation associated with pedaling. Fourteen stroke and 12 control subjects were asked to pedal a custom, MRI-compatible device during fMRI. Subjects also performed lower limb tapping to localize brain regions involved in lower limb movement. All stroke and control subjects were able to pedal while positioned for fMRI. Two control subjects were withdrawn due to claustrophobia, and one control data set was …

Robotic Resistance/Assistance Training Improves Locomotor Function In Individuals Poststroke: A Randomized Controlled Study, Ming Wu, Jill M. Landry, Janis Kim, Brian D. Schmit, Sheng-Che Yen, Jillian Macdonald

Biomedical Engineering Faculty Research and Publications

Objective

To determine whether providing a controlled resistance versus assistance to the paretic leg at the ankle during treadmill training will improve walking function in individuals poststroke.

Design

Repeated assessment of the same patients with parallel design and randomized controlled study between 2 groups.

Setting

Research units of rehabilitation hospitals.

Participants

Patients (N=30) with chronic stroke.

Intervention

Subjects were stratified based on self-selected walking speed and were randomly assigned to the resistance or assistance training group. For the resistance group, a controlled resistance load was applied to the paretic leg at the ankle to resist leg swing during treadmill walking. …

Topical Menthol, Ice, Peripheral Blood Flow, And Perceived Discomfort, Robert V. Topp, Elizabeth R. Ledford, Dean E. Jacks

College of Nursing Faculty Research and Publications

Context : Injury management commonly includes decreasing arterial blood flow to the affected site in an attempt to reduce microvascular blood flow and edema and limit the induction of inflammation. Applied separately, ice and menthol gel decrease arterial blood flow, but the combined effects of ice and menthol gel on arterial blood flow are unknown.

Objectives : To compare radial artery blood flow, arterial diameter, and perceived discomfort before and after the application of 1 of 4 treatment conditions.

Design : Experimental crossover design.

Setting : Clinical laboratory.

Participants or Other Participants : Ten healthy men, 9 healthy women (mean …

Reciprocal Inhibition Post-Stroke Is Related To Reflex Excitability And Movement Ability, Neha Bhagchandani, Sheila M. Schindler-Ivens

Physical Therapy Faculty Research and Publications

Objective Decreased reciprocal inhibition (RI) of motor neurons may contribute to spasticity after stroke. However, decreased RI is not a uniform observation among stroke survivors, suggesting that this spinal circuit may be influenced by other stroke-related characteristics. The purpose of this study was to measure RI post-stroke and to examine the relationship between RI and other features of stroke. Methods RI was examined in 15 stroke survivors (PAR) and 10 control subjects by quantifying the effect of peroneal nerve stimulation on soleus H-reflex amplitude. The relationship between RI and age, time post-stroke, lesion side, walking velocity, Fugl-Meyer, Ashworth, and Achilles …

Robotic Resistance Treadmill Training Improves Locomotor Function In Human Spinal Cord Injury: A Pilot Study, Ming Wu, Jill M. Landry, Brian Schmit, T. George Hornby, Sheng-Che Yen

Biomedical Engineering Faculty Research and Publications

Objective

To determine whether cable-driven robotic resistance treadmill training can improve locomotor function in humans with incomplete spinal cord injury (SCI).

Design

Repeated assessment of the same patients with crossover design.

Setting

Research units of rehabilitation hospitals in Chicago.

Participants

Patients with chronic incomplete SCI (N=10) were recruited to participate in this study.

Interventions

Subjects were randomly assigned to 1 of 2 groups. One group received 4 weeks of assistance training followed by 4 weeks of resistance training, while the other group received 4 weeks of resistance training followed by 4 weeks of assistance training. Locomotor training was provided by …

Pedaling Alters The Excitability And Modulation Of Vastus Medialis H-Reflexes After Stroke, Dana P. Fuchs, Namita Sanghvi, Jon A. Wieser, Sheila Schindler-Ivens

Physical Therapy Faculty Research and Publications

Objective

Individuals post-stroke display abnormal Group Ia reflex excitability. Pedaling has been shown to reduce Group Ia reflexes and to normalize the relationship between EMG and reflex amplitude in the paretic soleus (SO). The purpose of this study was to determine whether these changes extend to the paretic quadriceps.

Methods

H-reflexes were used to examine Group Ia reflex excitability of the vastus medialis (VM). H-reflexes were elicited in paretic (n = 13) and neurologically intact (n = 13) individuals at 11 positions in the pedaling cycle and during static knee extension at comparable limb positions and levels of …

Observation Of Amounts Of Movement Practice Provided During Stroke Rehabilitation, Catherine E. Lang, Jillian R. Macdonald, Darcy S. Reisman, Lara Boyd, Teresa Jacobson Kimberley, Sheila M. Schindler-Ivens, T. George Hornby, Sandy A. Ross, Patricia L. Scheets

Physical Therapy Faculty Research and Publications

Objective

To investigate how much movement practice occurred during stroke rehabilitation, and what factors might influence doses of practice provided.

Design

Observational survey of stroke therapy sessions.

Setting

Seven inpatient and outpatient rehabilitation sites.

Participants

We observed a convenience sample of 312 physical and occupational therapy sessions for people with stroke.

Interventions

Not applicable.

Main Outcome Measures

We recorded numbers of repetitions in specific movement categories and data on potential modifying factors (patient age, side affected, time since stroke, FIM item scores, years of therapist experience). Descriptive statistics were used to characterize amounts of practice. Correlation and regression analyses were …

Parallel Facilitatory Reflex Pathways From The Foot And Hip To Flexors And Extensors In The Injured Human Spinal Cord, Maria Knikou, Elizabeth Kay, Brian D. Schmit

Biomedical Engineering Faculty Research and Publications

Spinal integration of sensory signals associated with hip position, muscle loading, and cutaneous sensation of the foot contributes to movement regulation. The exact interactive effects of these sensory signals under controlled dynamic conditions are unknown. The purpose of the present study was to establish the effects of combined plantar cutaneous afferent excitation and hip movement on the Hoffmann (H) and flexion reflexes in people with a spinal cord injury (SCI). The flexion and H-reflexes were elicited through stimulation of the right sural (at non-nociceptive levels) and posterior tibial nerves respectively. Reflex responses were recorded from the ipsilateral tibialis anterior (TA) …

Pre- And Post-Alpha Motoneuronal Control Of The Soleus H-Reflex During Sinusoidal Hip Movements In Human Spinal Cord Injury, Maria Knikou, Debjani Chaudhuri, Elizabeth Kay, Brian D. Schmit

Biomedical Engineering Faculty Research and Publications

The aim of this study was to establish the contribution of hip-mediated sensory feedback to spinal interneuronal circuits during dynamic conditions in people with incomplete spinal cord injury (SCI). Specifically, we investigated the effects of synergistic and antagonistic group I afferents on the soleus H-reflex during imposed sinusoidal hip movements. The soleus H-reflex was conditioned by stimulating the common peroneal nerve (CPN) at short (2, 3, and 4 ms) and long (80, 100, and 120 ms) conditioning test (C-T) intervals to assess the reciprocal and pre-synaptic inhibition of the soleus H-reflex, respectively. The soleus H-reflex was also conditioned by medial …

Motivating Rehabilitation By Distorting Reality, James L. Patton, Yejun Wei, Chris Scharver, Robert V. Kenyon, Robert A. Scheidt

Biomedical Engineering Faculty Research and Publications

We have found, through a series of recent experiments, encouraging evidence that the neuro-motor system is motivated to change motor patterns when exposed to visuo-motor tasks. We have also shown that the learning of these tasks can be heightened with forces and/or visual distortions that appropriately manipulate the error. This process does not require intense concentration and it is often considered a game. We describe the next generation of robotic large-workspace, three dimensional haptics/graphics systems for rehabilitation

A Physiologically Based Clinical Measure For Spastic Reflexes In Spinal Cord Injury, Ela N. Benz, T. George Hornby, Rita K. Bode, Robert A. Scheidt, Brian D. Schmit

Biomedical Engineering Faculty Research and Publications

Objective: To test the validity of the Spinal Cord Assessment Tool for Spastic reflexes (SCATS), a clinical tool intended to rate spastic motor behavior after spinal cord injury (SCI).

Design: By using correlational analyses, the SCATS was validated using concurrent measurements of kinematics and electromyograms and traditional assessments of spasms and spastic hypertonia.

Setting: Research laboratory (kinematics and electromyography) and outpatient medical clinic (traditional measures of spastic hypertonia).

Participants: Eleven people with SCI were used for kinematic and electromyographic measurements. Seventeen people with SCI were used for comparison with other clinical scales.

Interventions: Not applicable. …

Computerized Biofeedback Knee Goniometer: Acceptance And Effect On Exercise Behavior In Post-Total Knee Arthroplasty Rehabilitation, Todd A. Kuiken, Hagay Amir, Robert A. Scheidt

Biomedical Engineering Faculty Research and Publications

Objective

To assess device accuracy, patient acceptance, and effect of a computerized biofeedback knee goniometer (CBG), on patients’ compliance with active range of motion (AROM) exercises after total knee arthroplasty (TKA).

Design

Two-stage study: measurement validation on asymptomatic controls and an unblinded, multiple crossover trial.

Setting

Inpatient rehabilitation.

Participants

Asymptomatic controls (n=14) and post-TKA inpatients (n=11).

Interventions

For measurement validation, CBG-angle measurements were compared with manual, clinician-obtained angles. To assess motivational effect, the CBG was worn after TKA; on alternating days, it either monitored AROM silently (no feedback) or provided audiovisual feedback about reaching preset range of motion (ROM) goals …

A Rehabilitation Engineering Course For Biomedical Engineers, M. Barbara Silver-Thorn

Biomedical Engineering Faculty Research and Publications

This paper describes an upper division elective course in rehabilitation engineering that addresses prosthetics and orthotics, wheelchair design, seating and positioning, and automobile modifications for individuals with disabilities. Faculty lectures are enhanced by guest lectures and class field trips. Guest lecturers include a prosthetist and a lower extremity amputee client, an engineer/prosthetist specializing in the upper extremity, and a rehabilitation engineer. The lower extremity prosthetist and his client present a case study for prosthetic prescription, fabrication, fitting, alignment, and evaluation. The engineer/prosthetist contrasts body-powered versus externally powered upper extremity prostheses and associated design, fitting, and functional considerations; he also discusses …