title: Learning to use a body-powered prosthesis: changes in functionality and kinematics.
abstract: Little is known about action-perception learning processes underlying prosthetic skills in body-powered prosthesis users. Body-powered prostheses are controlled through a harness connected by a cable that might provide for limited proprioceptive feedback. This study aims to test transfer of training basic tasks to functional tasks and to describe the changes over time in kinematics of basic tasks of novice body-powered prosthesis users.
  
  
  
  Thirty able-bodied participants and 17 controls participated in the study, using a body-powered prosthetic simulator. Participants in the training group were divided over four groups and practiced during a 2-week-period either direct grasping, indirect grasping, fixation, or a combination of these tasks. Deformable objects with different compliances had to be manipulated while kinematic variables and grip force control were assessed. Functional performance was measured with the Southampton Hand Assessment Procedure (SHAP) prior to and after the training sessions, and after 2 weeks and 3 months retention. The control group only performed the SHAP tests.
  
  
  
  All four training groups and the control group improved on the SHAP, also after a period of non-use. Type of training had a small but significant influence on the improvements of the SHAP score. On a kinematic level movement times decreased and hook closing velocities increased over time. The indirect grasping group showed significantly shorter plateau times than the other training groups. Grip force control only improved a little over training.
  
  
  
  Training action-perception couplings of body-powered prosthesis in basic tasks transferred to functional tasks and this lasted after a period of non-use. During training movement times decreased and the indirect grasping group showed advantages. It is advisable to start body-powered training with indirect grasping tasks but also to practice hook-object orientations.
authors.affiliation: Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 196, Groningen, NL-9700 AD, The Netherlands.
authors.forename: Laura H B
authors.initials: LH
authors.lastname: Huinink
authors.affiliation: Adelante Rehabilitation Centre, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.|Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Bouwsema
authors.affiliation: Department of BioMechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, The Netherlands.
authors.forename: Dick H
authors.initials: DH
authors.lastname: Plettenburg
authors.affiliation: Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Corry K
authors.initials: CK
authors.lastname: van der Sluis
authors.affiliation: Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, UMCG sector F, FA 23, PO Box 196, Groningen, NL-9700 AD, The Netherlands. r.m.bongers@umcg.nl.
authors.forename: Raoul M
authors.initials: RM
authors.lastname: Bongers
mesh_terms: D001186:Artificial Limbs; D001696:Biomechanical Phenomena; D056228:Feedback, Sensory; D005260:Female; D018737:Hand Strength / Q000502:physiology; D064368:Healthy Volunteers; D006801:Humans; D007858:Learning; D008297:Male; D019736:Prostheses and Implants; D055815:Young Adult
keywords: Action-perception; Amputee; Body-powered prosthetic hook; Functional performance; Grip force control; Kinematics; Proprioceptive feedback; Prosthetic training; Upper-limb prosthesis