The provision of upper limb prosthetic devices through the National Health Services (NHS) within the United Kingdom is driven by national policies. NHS England have recently published a new policy to provide multi-grip myoelectric hands. The policy highlighted that there was limited evidence to support its deployment and it will be reviewed should new information arise. The clear identification of the evidence gap provides an opportunity for the academic research community to conduct studies that will inform future iterations of this and other upper limb prosthetic related policies. This paper presents a summary of findings and recommendations based on two multi-stakeholder workshops held in June 2022 and July 2022, which explored the design requirements for policy-driven research studies. The workshops involved people from a broad range of stakeholder groups: policy, academia, NHS clinical and management, industry, and a person with upper limb absence. The workshop discussions focused on the research questions that NHS England identified in the policy evidence review: (1) Clinical Effectiveness; (2) Cost Effectiveness; (3) Safety; and (4) Patient Subgroups. The recommendations based on stakeholder discussions included the need to gather qualitative and quantitative research evidence, use goal-based outcome measures, and conduct longitudinal studies. Future research studies also need to address the complexities of conducting national and international policy-driven research, such as clinical resource capacity and participant involvement.

Cybathlon championship aims at promoting the development of prosthetic and assistive devices capable to meet users\' needs. This paper describes and analyses possible exploitation outcomes of our team\'s (REHAB TECH) experience into the Powered Arm Prosthesis Race of the Cybathlon 2020 Global Edition, with the novel prosthetic system Hannes. In detail, we present our analysis on a concurrent evaluation conducted to verify if the Cybathlon training and competition positively influenced pilot\'s performance and human-technology integration with Hannes, with respect to a non-runner Hannes user.
Two transradial amputees were recruited as pilots (Pilot 1 and Pilot 2) for the Cybathlon competition and were given the polyarticulated myoelectric prosthetic hand Hannes. Due to COVID-19 emergency, only Pilot 1 was trained for the race. However, both pilots kept Hannes for Home Use for seven weeks. Before this period, they both participated to the evaluation of functionality, embodiment, and user experience (UX) related to Hannes, which they repeated at the end of the Home Use and right after the competition. We analysed Pilot 1\'s training and race outcomes, as well as changes in the concurrent evaluation, and compared these results with Pilot 2\'s ones.
The Cybathlon training gradually improved Pilot 1\'s performances, leading to the sixth place with a single error in task 5. In the parallel evaluation, both pilots had an overall improvement over time, whereas Pilot 2 experienced a deterioration of embodiment. In detail, Pilot 1, who followed the training and raced the Cybathlon, improved in greater way.
Hannes demonstrated to be a valuable competitor and to perform grasps with human-like behaviors. The higher improvements of Pilot 1, who actively participated in the Cybathlon, in terms of functionality, embodiment and UX, may depend on his training and engagement in the effort of achieving a successful user-prosthesis interaction during the competition. Tasks based on Cybathlon\'s ones could improve the training phase of a prosthetic user, stimulating dexterity, prosthetic integration, and user perception towards the prosthesis. Likewise, timed races or competitions could facilitate and accelerate the learning phase, improving the efficiency and efficacy of the process.

The purpose of this study was to explore a range of perspectives on how academic research and clinical assessment of upper-limb prosthetics could happen in environments outside of laboratories and clinics, such as within peoples\' homes. Two co-creation workshops were held, which included people who use upper limb prosthetic devices (hereafter called users), clinicians, academics, a policy stakeholder, and a representative from the upper-limb prosthetics industry (hereafter called professionals). The discussions during the workshops indicate that research and clinical assessment conducted remotely from a laboratory or clinic could inform future solutions that address user needs. Users were open to the idea of sharing sensor and contextual data from within their homes to external laboratories during research studies. However, this was dependent upon several considerations, such as choice and control over data collection. Regarding clinical assessment, users had reservations of how data may be used to inform future prosthetic prescriptions whilst, clinicians were concerned with resource implications and capacity to process user data. The paper presents findings of the discussions shared by participants during both workshops. The paper concludes with a conjecture that collecting sensor and contextual data from users within their home environment will contribute towards literature within the field, and potentially inform future care policies for upper limb prosthetics. The involvement of users during such studies will be critical and can be enabled via a co-creation approach. In the short term, this may be achieved through academic research studies, which may in the long term inform a framework for clinical in-home trials and clinical remote assessment.

STUDY DESIGN\": Qualitative research design using interpretative phenomenological analysis (IPA) to interpret users\' experiences with digital prostheses.
Digital prostheses are rarely used, and little is known about the experiences of traumatic finger amputees with digital prostheses. When advising patients regarding digital prostheses, it is crucial for professionals to understand users experiences of wearing a digital prosthesis and the meaning attached to wearing a digital prosthesis.
The aim of this study was to explore and understand users experiences of wearing a digital prostheses in daily functioning.
Individual semi-structured interviews were conducted, recorded, and transcribed. The written interview texts were analysed following Interpretative phenomenological analysis guidelines.
Four participants were interviewed. They experienced the prostheses as valuable additions to their daily functioning. Three different themes relating to wearing and using digital prostheses emerged from in-depth analysis of the data: How the prosthesis supporting them regaining a \'grip\' on life, reduced overload on unaffected side and restored body image.
This study provides a deeper understanding of the experiences of people with digital amputations who use prostheses. Most importantly, that a prosthesis is of crucial importance for participants to be able to act independently and autonomously as well as to participate in family, work and social environments. This insight will help practitioners when considering, with clients the most appropriate digital prosthesis to meet their goals.

BACKGROUND: Upper limb research is currently lacking detailed clinical guidance on the provision of unilateral transradial prostheses. Clinical practice guidelines are meant to serve as assistance for the decision-making process, and Delphi surveys have been used with increasing frequency within orthotics and prosthetics to create these guidelines for clinical practice.
METHODS: A three round Delphi survey was used to gain consensus on clinical statements regarding unilateral transradial prostheses.
RESULTS: We achieved consensus (> 80% agreement) on a total of 40 statements by surveying 22 experts on upper limb prosthetics over three rounds of surveys. Response rate ranged from 81.8-86.4% with a total of 55 total statements under consideration throughout the duration of the survey. The 40 passing statements were arranged into nine guidelines for provision of prosthetic care in this population.
CONCLUSIONS: The Delphi technique allowed for the creation of a set of clinical practice guidelines for the unilateral transradial patient in the absence of conclusive empirical evidence.

People who either use an upper limb prosthesis and/or have used services provided by a prosthetic rehabilitation centre, experience limitations of currently available prosthetic devices. Collaboration between academia and a broad range of stakeholders, can lead to the development of solutions that address peoples\' needs. By doing so, the rate of prosthetic device abandonment can decrease. Co-creation is an approach that can enable collaboration of this nature to occur throughout the research process. We present findings of a co-creation project that gained user perspectives from a user survey, and a subsequent workshop involving: people who use an upper limb prosthesis and/or have experienced care services (users), academics, industry experts, charity executives, and clinicians. The survey invited users to prioritise six themes, which academia, clinicians, and industry should focus on over the next decade. The prioritisation of the themes concluded in the following order, with the first as the most important: function, psychology, aesthetics, clinical service, collaboration, and media. Within five multi-stakeholder groups, the workshop participants discussed challenges and collaborative opportunities for each theme. Workshop groups prioritised the themes based on their discussions, to highlight opportunities for further development. Two groups chose function, one group chose clinical service, one group chose collaboration, and another group chose media. The identified opportunities are presented within the context of the prioritised themes, including the importance of transparent information flow between all stakeholders; user involvement throughout research studies; and routes to informing healthcare policy through collaboration. As the field of upper limb prosthetics moves toward in-home research, we present co-creation as an approach that can facilitate user involvement throughout the duration of such studies.

Objective.Lack of sensation from a hand or prosthesis can result in substantial functional deficits. Surface electrical stimulation of the peripheral nerves is a promising non-invasive approach to restore lost sensory function. However, the utility of standard surface stimulation methods has been hampered by localized discomfort caused by unintended activation of afferents near the electrodes and limited ability to specifically target underlying neural tissue. The objectives of this work were to develop and evaluate a novel channel-hopping interleaved pulse scheduling (CHIPS) strategy for surface stimulation that is designed to activate deep nerves while reducing activation of fibers near the electrodes.Approach.The median nerve of able-bodied subjects was activated by up to two surface stimulating electrode pairs placed around their right wrist. Subjects received biphasic current pulses either from one electrode pair at a time (single-channel), or interleaved between two electrode pairs (multi-channel). Percept thresholds were characterized for five pulse durations under each approach, and psychophysical questionnaires were used to interrogate the perceived modality, quality and location of evoked sensations.Main results.Stimulation with CHIPS elicited enhanced tactile percepts that were distally referred, while avoiding the distracting sensations and discomfort associated with localized charge densities. These effects were reduced after introduction of large delays between interleaved pulses.Significance.These findings demonstrate that our pulse scheduling strategy can selectively elicit referred sensations that are comfortable, thus overcoming the primary limitations of standard surface stimulation methods. Implementation of this strategy with an array of spatially distributed electrodes may allow for rapid and effective stimulation fitting. The ability to elicit comfortable and referred tactile percepts may enable the use of this neurostimulation strategy to provide meaningful and intuitive feedback from a prosthesis, enhance tactile feedback after sensory loss secondary to nerve damage, and deliver non-invasive stimulation therapies to treat various pain conditions.

OBJECTIVE: For infants and small toddlers with congenital upper limb deficiencies, terminal devices mainly provide either cosmesis or functionality. We report a clinical note about fitting a child with a low-cost passive hand targeting both functionality and cosmesis.
METHODS: An elastomeric, alloy-wire-reinforced hand was fabricated using additive manufacturing to allow independent positioning of the digits. A clinical pilot in-home evaluation was conducted on a child with upper limb loss.
CONCLUSIONS: The fabricated hand met the functional requirements but required a cover for cosmesis due to a poor surface finish associated with the fabrication technique. The participant child was comfortable using the prosthesis for various tasks. The parents were satisfied with the hand\'s function and cosmesis when covered with a cosmetic glove. This work demonstrated a new design and process that may in the future improve the utilization of prosthetic hands to promote early prosthesis use and a child\'s development.
CONCLUSIONS: Early prosthesis use is important for infants and toddlers. Additive manufacturing may enable the fabrication of custom passive prosthetic hands that provide both cosmesis and functionality.

UNASSIGNED: Loss of the hand results in significant functional deficits and requires adaptation of movement patterns which may result in overuse injuries. An externally powered prosthesis may improve function of the affected limb and reduce the overreliance on the intact side; however, little research has been done in this area.
UNASSIGNED: Investigate changes in upper limb function and kinematics in individuals with partial-hand amputations performing a functional assessment by comparing results with and without a multi-articulating hand prosthesis.
UNASSIGNED: Cross-sectional.
UNASSIGNED: Three-dimensional kinematics of four- and five-digit limb loss participants were collected as they performed the Southampton Hand Assessment Procedure with and without a prothesis.
UNASSIGNED: Ten males completed the protocol: five with four-digit loss (thumb intact) and five with five-digit loss. Significantly larger joint motions were seen without the prosthesis than with for all participants, which may be an indicator of higher risk for overuse injury. Significant improvement was seen in Southampton Hand Assessment Procedure scores in the five-digit limb loss participants using the prosthesis compared with not using the device (p < 0.05 for 6/7 Southampton Hand Assessment Procedure score categories).
UNASSIGNED: The prosthesis reduced functional deficits and decreased joint range of motion in individuals with partial hand loss. Results showed reduced compensatory motions throughout the upper limb and torso which may reduce the risk of overuse injury.
CONCLUSIONS: Results of this study indicate that externally powered partial hand prostheses can be effective in improving function and reducing compensation in individuals with partial hand loss.

UNASSIGNED: The refined clothespin relocation test is a test used to evaluate the performance of a prosthesis user by analysing the compensatory motions and time to complete a grasping and placement exercise. The test has been studied previously with a motion capture laboratory and has now been adapted for a clinical setting. A comparison of prosthesis user to an able-bodied group is needed to determine efficacy as an assessment tool.
UNASSIGNED: To modify the previous refined clothespin relocation test and assess whether it can distinguish between able-bodied and prosthesis users.
UNASSIGNED: Comparative analysis.
UNASSIGNED: Forty-two able-bodied subjects and three prosthesis users completed the adapted refined clothespin relocation test protocol. Average refined clothespin relocation test scores describing the degree of compensatory movements and the time to complete the protocol were compared using a Mann-Whitney U-test.
UNASSIGNED: A significant difference was found in the refined clothespin relocation test score between the able-bodied (Md = 65.32, n = 42) and prosthesis users (Md = 23.07, n = 3) with a medium effect size (p < 0.001, r = 0.43).
UNASSIGNED: Prosthesis users demonstrated larger compensations and longer completion times, as reflected in the refined clothespin relocation test final score. The refined clothespin relocation test has the potential to be a useful clinical tool to assess user performance on a functional task.
CONCLUSIONS: This preliminary study demonstrates that the adapted protocol can distinguish between the two groups based on refined clothespin relocation test score. A future multi-centre study is required using multiple raters and comparing it with the existing outcome measures to validate the refined clothespin relocation test and determine inter-rater reliability.