A new measure of activity performance for adults with upper limb amputation measures how adequately they are able to perform and complete certain tasks.

“We needed a performance based measure of activity for adults with upper limb amputation for a research study I was conducting on the DEKA Arm and there was no measure to turn to that had been validated for adults with upper limb amputations,” Linda Resnik, PhD, associate research professor in public health at Brown University and a research scientist at the Providence Veterans Affairs Medical Center, told O&P Business News. “We set about developing our own measure because we wanted a reliable and valid measure that we could use to assess effectiveness.”

AM-ULA

The Activities Measure for Upper Limb Amputees (AM-ULA) provides standardized methods and criteria for clinicians to grade patients’ performance, speed, movement quality, skillfulness of prosthetic use and independence with a prosthetic limb.

Forty-nine veterans with upper limb amputation from Veterans Affairs (VA) facilities in Tampa, Fla., New York and the US Army’s Fort Sam Houston in Texas participated in a cohort study in which 18 everyday tasks — such as putting on and removing a shirt, serving soda from a can, combing hair, tying shoes and using a spoon — were measured by the AM-ULA. Participants were videotaped and graded by two independent raters.

Overall, researchers found that participants with more distal levels of limb loss had better scores vs. participants with more proximal levels. Most dexterity tests and self-reported function moderately correlated with the AM-ULA.

“Patients can’t just take a prosthesis out of a box and start using it skillfully,” Resnik stated in a press release. “Patients need training to make the most of an upper limb prosthesis. Physical and 
occupational therapists train people to use adaptive equipment and prosthetic devices — teaching them strategies to accomplish functional tasks, and guiding them in therapeutic exercises and activities. Outcome measures are needed in all areas of health care, but particularly so in the area of prosthetic rehabilitation. We need measures to let us know if our patients are improving the way that we expect them to.”

Clear scoring guidelines

To develop the new set of measurements, Resnik and colleagues first looked at several self-report measures that had been used in the field, including an activities checklist and an upper extremity functional scale. Once they had the measures they wanted to use, the group came up with a very clear scoring guideline for each of the activities being performed.

“We first specifically defined each task. Knowing everything was to be standardized, we had to break each of the functional tasks down and we defined from beginning to end what all the subtasks were,” Resnik said. “Then when we talked about what made sense in terms of how we graded performance we looked at what was clinically important.”

After administering the measurements, watching the recorded videos and discussing the actions, the group discussed what components should be considered for the grading criteria. They defined what every grade meant, grip, body compensation, speed and completion of the activity. Although developing the measure took some time, Resnik believes that they developed a very reliable test.

“[The AM-ULA] is a way that occupational therapists, physical therapists, prosthetists, or PMR physicians can assess the status of an upper limb amputee and can give them a performance-based measure to look at activity performance,” Resnik said. “We want to be able to assess how our patients are doing over time and the impact of a new or existing device. It will help give us data to know what people actually get out of some of the high tech devices we give them.” — by Casey Murphy

Disclosure: The study was supported with a grant from the Department of Veterans Affairs. Resnik has no relevant financial disclosures.