Copyright 1993 by The Journal of Bone and Joint Surger.

v, Incorporated

Myoelectric Prostheses
A LONG-TERM FOLLOW-UP AND A STUDY OF THE USE OF ALTERNATE PROSTHESES*

BY D. HAL SILCOX. III. M.D.t. MICHAEL D. ROOKS. M.D4. ROBERT R. VOGEL, MDI, AND LAMAR L. FLEMING, M.D 4,
ATLANTA, GEORGIA

Investigation performed at the Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta

ABSTRACT: Forty-four patients who had had a total Before the advent of the myoelectric prosthesis and
of forty-seven amputations of an upper extremity the use of modern techniques of rehabilitation, accep-
and who had had a myoelectric prosthesis for more tance of upper-extremity prostheses had been poor; rates
than two years were evaluated retrospectively for the of rejection of 67 and 50 per cent were reported5’#{176}. More
amount of use of the prosthesis, the use of any other recently, studies have shown a decline in the rejection of
prosthesis, and the demographic factors that might be these prostheses348. In 1985, Heger et al. reported a 22
related to use of the prosthesis. The average duration per cent rate of rejection by patients who had had an
of follow-up was five years (range, twenty-five months amputation of the upper extremity and who had been
to seventeen years). Forty of the forty-four patients fitted with a myoelectric arm. However, the duration of
also had a conventional prosthesis. follow-up in this series was less than three years.
Twenty-two patients (50 per cent) rejected the The purposes of the present study were to examine
myoelectric prosthesis completely; thirteen (32 per the acceptance and usage of myoelectric prostheses -

cent) of the forty patients who also had a conventional and of alternate prostheses by those who owned both
prosthesis rejected the conventional prosthesis com- - and to identify demographic factors that are associ-
pletely. The patients who used the myoelectric device ated with the use of these prostheses.
the least were employed in occupations that required
high-demand use of the prosthesis (lifting of more than Materials and Methods
4.5 kilograms [ten pounds] or repetitive manual labor) Sixty-one patients who had had an amputation of an
or were receiving or seeking Workers’ Compensation, upper extremity were fitted with a myoelectric prosthe-
or both. sis at Emory University Affiliated Hospitals, from Jan-
uary 1972 through December 1989. The indications for
Published drawings both of pneumatic and of elec- prescription of the myoelectric prosthesis evolved with
tric prosthetic hands show that the concept of externally time. Initially, a myoelectric device was prescribed for
powered upper-extremity prostheses existed early in the all patients who were found to use a conventional pros-
twentieth century, but the implementation of these ideas thesis very well and who were interested in the concept
quickly perished because of the lack of a portable en- of a myoelectric device, as long as the amputation stump
ergy source”. In 1949, Alderson of the United States showed no sign of infection and the skin was intact and
built the first electrically powered prosthetic hand, but had excellent sensation. Later, following the success of
subsequent work yielded discouraging results and inter- immediate fitting of a prosthesis7, all patients who had
est in electric prostheses had apparently subsided by had an acute amputation received a myoelectric unit.
1953”. With the use of results from myoelectric research Contraindications to the prescription of a myoelectric
in Germany, Russian scientists developed the first myo- prosthesis included infection of the stump, paralysis or
electric arm in 1958’’. This milestone, coupled with the lack of sensation in the stump, and any apparent ambiv-
number of patients who had thalidomide-induced con- alence on the part of the patient about the use of a
genital limb deformities, sparked international interest myoelectric device.
in the research and development of the modern myo- To be included in the study, the patient had to have
electric prosthesis”. had the myoelectric prosthesis for more than two years.
Of the sixty-one patients, two were excluded from the
*No benefits in any form have been received or will be received study because they had had the prosthesis for less than
from a commercial party related directly or indirectly to the subject two years, one patient had died and no information was
of this article. No funds were received in support of this study.
tSection of Orthopaedics, Emory Clinic Sports Medicine Cen-
available on his usage of the prosthesis, and fourteen
ter, 2165 North Decatur Road, Decatur, Georgia 30033. Please ad- patients had been lost to follow-up. The study popula-
dress requests for reprints to Dr. Silcox. tion thus comprised forty-four patients who had had a
lDepartment of Orthopaedic Surgery, Emory University School
of Medicine, 69 Butler Street, Suite 402, Atlanta, Georgia 30303. total of forty-seven amputations of an upper extremity
§969 Plumas Street, Suite 116, Uba, California 95991. and who owned a total of forty-five myoelectric units.

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1782 D. H. SILCOX. III. M. D. ROOKS. R. R. VOGEL. AND L. L. FLEMING

TABLE I
RELATIONSHIP BETWEEN DEMOGRAPHIC FA-rORS AND USE OF A MYOELETRIC PROSTHESIS

Myoelectric Prosthesis Usage8

Demographic Factor Excellent Good Poor Rejection

Sex
Male(n=36) 10(28) 2(6) 6(17) 18(50)
Female(n=8) 2 2 0 4
Reason for amputation
Trauma (n = 40)
During military service (n = 7) 3 0 1 3
Motor-vehicle accident (n = 5) 2 0 1 2
Workrelatedt(n=28) 6(21) 4(14) 3(11) 15(54)
Other(n=4) 1 0 1 2
Timing of fit
Immediate (n = 5) 2 1 0 2
1-7 days (n = 3) 1 0 0 2
8-3odays(na4) 1 0 1 2
>3Odaysl(n=32) 7(22) 4(13) 5(16) 16(50)
Dominant hand lost
Yes(n=29) 7(24) 4(14) 4(14) 14(48)
No(n=13) 5 0 1 7
Not applicablel (n = 2) 0 0 1 1
Job
Heavy demand (n = 19) 3 2 4 10
Lightdemand(n=25) 9(36) 2(8) 2(8) 12(48)
Training
Yes(n=37) 8(22) 3(8) 6(16) 20(54)
No(n=7) 4 1 0 2
Feedbacki
Best from myoelectric (n = 14) 7 2 1 4
Best from conventional (n = 8) 1 0 0 7
Same from both (n = 3) 1 0 1 1
None from either (n = 19) 3 2 4 10

*The number of patients, with the percentage in parentheses.

tWork-related accidents that resulted in Workers’ Compensation litigation.
lThis group includes two patients who had a congenital amputation.
§This group includes four patients who did not own both prostheses and thus could rate only the myoelectric prothesis.

Of these forty-four patients, forty (91 per cent) owned a bilateral amputation. In twenty-nine patients (66 per
a conventional-type prosthesis and nine (20 per cent) cent), the amputation was on the dominant side or was
owned a cosmetic prosthesis in addition to the myoelec- bilateral, and in thirteen patients (30 per cent), it was on
tric unit. the non-dominant side. In the two patients (5 per cent)
The average age of the patients at the time of the who had had a congenital amputation, the side of domi-
prosthetic fitting was thirty-eight years (range, six to nance could not be assigned. Fitting of the prosthesis
sixty-nine years). There were thirty-six male patients (82 was done immediately after the amputation in five pa-
per cent) and eight female patients (18 per cent). The tients, one to seven days after the amputation in three
average duration of follow-up was five years (range, patients, eight to thirty days after the amputation in four
twenty-five months to seventeen years). patients, and more than thirty days after the amputation
Forty (91 per cent) of the patients had had an am- in thirty-two patients. Nineteen patients had an occupa-
putation because of trauma: twenty-eight patients had tion that made heavy demands on the prosthesis and
had a work-related accident that resulted in the ampu- twenty-five, light demands (Table I). At the most recent
tation and were receiving or seeking Workers’ Compen- follow-up evaluation, the time since the amputation
sation, seven patients had sustained the injury during ranged from four to forty-six years.
military service, and five patients had been involved in Of the forty patients who also owned a conventional
a motor-vehicle accident (Table I). Of the remaining prosthesis, thirty-three (83 per cent) had used the con-
four patients (9 per cent), one lost the upper extremity ventional prosthesis before receiving the myoelectric
because of vascular insufficiency; one, because of a tu- prosthesis and seven (18 per cent) had received the
mor; and two, because of a congenital deformity. Of the conventional prosthesis after having had the myoelec-
forty-seven amputation sites, thirty-two (68 per cent) tric unit. The average time that a patient had used a
were distal to the elbow, twelve (26 per cent) were prox- conventional prosthesis before receiving a myoelectric
imal to the elbow, and three (6 per cent) were wrist unit was eight years (range, one month to forty-two
disarticulations. Three of the forty-four patients had had years).

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 MYOELECTRIC PROSTHESES 1783

TABLE II
RELATIONSHIP BETWEEN DEMOGRAPHIC FACTORS AND USE OF A CONVENTIONAL PROSTHESIS

Conventional P rosthesis Usage*

Demographic Factort Excellent Good Poor Rejection

Sex
Male(n=34) 10(29) 4(12) 11(32) 9(26)
Female(n=6) 1 0 1 4
Reason for amputation
Trauma (n = 36)
During military service (n = 5) 3 0 1 1
Motor-vehicle accident (n = 7) 4 0 2 1
Workrelated(n=24) 4(17) 4(17) 9(38) 7(29)
Other(n=4) 0 0 0 4
Dominant hand lost
Yes(n=26) 6(23) 2(8) 9(35) 9(35)
No(n=l2) 5 2 3 2
Not applicable (n = 2) 0 0 0 2
Job
Heavy demand (n = 17) 4 2 4 7
Light demand (n = 23) 7 (30) 2 (9) 8 (35) 6 (26)

*The number of patients. with the percentage in parentheses.

tlnformation on training or the time of prosthetic fitting was not available.
Work-related accidents that resulted in Workers’ Compensation litigation.
§Patients who had a congenital amputation.

Each patient was interviewed by one of us (D. H. S., had received, the reasons for use or rejection of the
III, or R. R. V.) with use of a standardized questionnaire. myoelectric prosthesis, their occupation, the time that
The patients were asked about the type of prosthe- had elapsed between the amputation and the prosthetic
ses that they owned (myoelectric, conventional, or cos- fitting, and whether there was any perception of sen-
metic), how much they used each prosthesis, the amount sory feedback. We considered patients to have received
of training in the use of the myoelectric unit that they training if they had been instructed by a certified occu-

50

40

30

20

10

0
Myoelectric Conventional Cosmetic

Type of Prosthesis
FIG. 1
Graph showing the rate of total rejection of each of the three types of prosthesis. No significant differences could be demonstrated with
these sample sizes.

VOL. 75-A, NO. 12. DECEMBER 1993

1784 D. H. SILCOX. III. M. D. ROOKS. R. R. VOGEL. AND L. L. FLEMING

25

20
Cl)
C
a)
15
0
0

a)
.0 10
E
z
5.1

0-’ - ----- --- ---

0% 1 -25% 26-50% 51 -75% 76-100%

Percent time that the prosthesis is used

N Home Work Social

FIG. 2-A
Figs. 2-A through 2-D: Graphs showing usage of the prostheses; the percentages of time were arbitrarily divided into quarters.
Fig. 2-A: Myoelectric prostheses.

pational therapist. Patients who, instead, had been in- alternative prosthesis. When a patient was retired or was
structed by a prosthetist were not considered to have unemployed, the time that the prosthesis was used dur-
received training. ing uncompensated work or was used at home was con-
We quantified the utilization of the prostheses with sidered to be time at work.
a system devised for this study. We asked the patients Next, we assigned points according to the percent-
to evaluate the time that they spent each day at home, age of time that the patient reported to have used the
at work, and in social situations. They were asked to prosthesis. Four points were assigned when the patient
quantify the percentage of time within each of these used the prosthesis 76 to 100 per cent of the time; 3
time-periods that they used or wore the myoelectric unit points, 51 to 75 per cent; 2 points, 26 to 50 per cent; 1
and the percentage of time that they used or wore an point, 1 to 25 per cent; and 0 points, not at all. The points

Cl)
C
a)
Ct

0
0
a)
.0
E
:,
z

0% 1 -25% 26-50% 51 -75% 76-100%

Percent time that the prosthesis is used

a Home Work Social

FIG. 2-B
Conventional prostheses.

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 MYOELECTRIC PROSTHESES 1785

5,

Cl)
C
4
a)
Ct
0.
0 3.
a)
.0
E 2
z
1

0
0% 1 -25% 26-50% 51 -75% 76-100%

Percent time that the prosthesis is used

N Home Work El Social

FIG. 2-C
Cosmetic prostheses.

assigned for each of the three time-periods (home, work, respectively. The total was 7 points, which classifies uti-
and social) were added; the total was considered to be lization of the myoelectric prosthesis as good.
the patient’s utilization grade. A utilization grade of 9 We evaluated the demographic characteristics of the
to 12 points indicated excellent use; S to 8 points, good patients relative to the utilization grades for the myo-
use; 1 to 4 points, poor use; and 0 points, rejection. electric and conventional prostheses. In addition, we
For example, when a patient used the myoelectric evaluated the usage of the myoelectric prosthesis in
prosthesis 50 per cent of the time at home, S per cent of relation to how long a patient had had a conventional
the time at work, and 100 per cent of the time in social prosthesis before being fitted for the myoelectric pros-
situations, the scores were 2 points, 1 point, and 4 points, thesis. For this purpose, we divided patients into sub-

25.

20
Cl)

C
a)
ft
0.

0
a)
.0
E
z

0% 1 -25% 26-50% 51 -75% 76-100%

Percent time that no prosthesis is used

. Home Work Social

FIG. 2-D

No prosthesis.

VOL. 75.A, NO. 12. DECEMBER 1993

1786 D. H. SILCOX, III. M. D. ROOKS. R. R. VOGEL. AND L. L. FLEMING

TABLE III
RELATIONSHIP BETWEEN PROSTHETIC USAGE AND THE LEVEL OF THE AMPUTATION

Prosthetic Usage*
Level of Amputation Excellent Good Poor Rejection

Myoelectric prosthesist
Wrist disarticulation (n = 3) 0 0 1 2
Distal to elbow (n = 30) 7 (23) 4 (13) 5 (17) 14 (47)
Proximal to elbow (n = 11) 4 1 0 6
Conventional prosthesis
Wrist disarticulation (n = 3) 1 2 0 0
Distal to elbow (n = 27) 7 (26) 2 (7) 10 (37) 8 (30)
Proximal to elbow (n = 10) 4 0 2 4

*TuI.j.tjfpatnts, with the percentage in parentheses.

tOnly the dominant side was tabulated for the patient who had bilateral myoelectric prostheses.

groups according to the length of time that they had three-quarters of the time, in social situations by ten
used a conventional prosthesis before fitting for the patients (25 per cent), at work by fourteen patients
myoelectric prosthesis: less than one year (thirteen pa- (35 per cent), and at home by ten patients (25 per cent)
tients), one to ten years (eleven patients), and more than (Fig. 2-B).
ten years (nine patients). The cosmetic prosthesis was used more than a quar-
We analyzed all results statistically with use of a ter of the time, in social situations by four of the nine
chi-square analysis test for independence with Yates patients who owned one, at work by one patient, and at
continuity correction (GB-Stat Professional Statistics home by none (Fig. 2-C).
and Graphics; Verslondo Dynamic Micro Systems, Sil- Twelve patients (27 per cent) used no prosthesis
ver Springs, Maryland), Spearman rank-order correla- three-quarters of the time in social situations; thirteen
tion test, regression analysis, or analysis of variance patients (30 per cent), three-quarters of the time at
(SAS; SAS Institute, Cary, North Carolina). The value work; and sixteen patients (36 per cent), three-quarters
of alpha was set at 0.05. With the number of compari- of the time at home (Fig. 2-D).
sons experimentwise there was a 0.40 chance of at least The grade for utilization of the myoelectric prosthe-
one spurious significant difference (1 - [1 - 0.05]’). sis was excellent for eleven patients (25 per cent), good
for five (11 per cent), and poor for six (14 per cent);
Results twenty-two (50 per cent) totally rejected the unit. Of the
Twenty-two (50 per cent) of the forty-four patients twenty-eight patients whose use of the myoelectric unit
rejected any use of the myoelectric prosthesis (Table I). was poor or non-existent, twenty-six also owned a con-
The conventional prosthesis was rejected by thirteen ventional prosthesis. For eleven (42 per cent) of the
(33 per cent) of the forty patients who had one (Table twenty-six patients, use of the conventional prosthesis
II), and the cosmetic prosthesis was rejected by five of was excellent.
the nine patients who had one (Fig. 1). The size of the The grade for utilization of the conventional pros-
sample was such that we could not demonstrate a sig- thesis for the forty patients who owned one was excel-
nificant difference in the rates of total rejection between lent for eleven (28 per cent), good for four (10 per cent),
the myoelectric and the conventional prostheses (chi- and poor for twelve (30 per cent); thirteen (33 per cent)
square analysis with Yates correction, p = 0.16); a sample totally rejected the unit.
size of about 104 patients in each group would have Of these forty patients, thirty-three had owned the
been needed (alpha = 0.05, beta = 0.8, two-tailed z test conventional prosthesis before being fitted with a myo-
with continuity correction). electric unit. We were not able to demonstrate a sig-
Twenty (50 per cent) of the forty patients who nificant association between the length of time that a
owned both a myoelectric prosthesis and a conventional patient had used the conventional prosthesis before be-
prosthesis rejected the myoelectric unit. Four (9 per ing fitted with a myoelectric prosthesis and acceptance
cent) of the forty-four patients owned only the myoelec- ( non-rejection) of the myoelectric unit.
tric prosthesis. Nine (23 per cent) of the forty patients We studied the relationship between various factors
who had a conventional prosthesis used the conven- and the utilization of myoelectric prostheses. With the
tional unit exclusively. small sample size, we were not able to show any signif-
The myoelectric prosthesis was used more than icant association between demographic factors and the
three-quarters of the time, in social situations by six- utilization of a myoelectric prosthesis using chi-square
teen patients (36 per cent), at work by twelve patients analysis. Use of Spearman rank-order tests, regression
(27 per cent), and at home by eight patients (18 per analysis or analysis of variance, and unpaired two-tailed
cent) (Fig. 2-A). t tests enabled us to find some significant correlations.
The conventional prosthesis was used more than There was a negative (inverse) correlation between

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 MYOELECTRIC PROSTHESES 1787

TABLE IV If all forty-four responses on myoelectric feedback

REASONS FOR USE AND NON-USE
were considered, regardless of whether or not the pa-
OF THE MYOELECFRIC PROSTHESIS
tient owned a conventional prosthesis, we found that
No. of Patients* nine of fourteen patients who believed that the myo-
Reasons for use electric unit provided feedback or better feedback than
Appearance 19 the conventional unit had excellent or good use of the
Ease of use 6 myoelectric unit. Twenty-one (78 per cent) of twenty-
No straps S
Novelty 4
seven patients who thought that the myoelectric unit
Helpful 3 provided less feedback than the conventional prosthesis,
Strength 2 or no feedback at all, either had poor use or had rejected
Feedback 2
the myoelectric prosthesis. Thus, the perception that the
Faster
myoelectric prosthesis gave better sensory feedback
Easier on stump
None 9 correlated with increased myoelectric utilization (cor-
Reasons for non-use relation coefficient, 0.33; p 0.03). Another finding with
Weight 16 regard to sensory feedback was that patients who had a
Speed 10 job that placed light demands on the prosthesis rated
Lack of durability 9
the myoelectric unit as giving good feedback, but pa-
Perspiration 5
Poor fit S tients whose occupation placed heavy demands on the
Difficult to operate 4 prosthesis tended to rate the myoelectric feedback as
Poor battery 3 poor (correlation coefficient, -0.300; p 0048).
Poor feedback 3
When the relationship between the level of the am-
Stiff elbow
Blindness putation and the patient’s occupational demand on the
Weak grip prosthesis was considered with regard to utilization of
None 6 the myoelectric prosthesis, we found that patients who
*The patients were allowed to cite more than one reason for use had had an above-the-elbow amputation and were em-
or non-use. ployed in a heavy-demand occupation were less likely
to accept the prosthesis compared with patients who
utilization of a myoetectric prosthesis and use of a con- had had an above-the-elbow amputation and had a
ventional prosthesis (r, = -0.44, p 0.004). light-demand occupation (unpaired two-tailed t test, p
Thirty-seven (84 per cent) of the forty-four patients 0.046). The utilization score of patients who had had
had received training from an occupational therapist a below-the-elbow amputation did not correlate with
(Table I). We found little if any (negative) correlation occupational demands. When the amputation had been
between this training and use of a myoelectric prosthe- done because of a work-related injury, a conventional
sis (r, = 0.31, p 0.04).
- Regression analysis and analysis prosthesis was not accepted by the patients who had had
of variance confirmed the finding that training did not an above-the-elbow amputation but was accepted by
influence the acceptance of a myoelectric prosthesis. those who had had a below-the-elbow amputation; this
The average myoelectric utilization score for patients difference was significant (unpaired two-tailed t test,
who had not received training from an occupational p 0.0001).
therapist was 8 points, whereas patients who had been We were not able to show a significant correlation
formally trained had an average utilization score of 3 between use of the myoetectric or conventional prosthe-
points (unpaired two-tailed t test, p 0.015). sis and the sex and age of the patient, the reason for the
Of the forty patients who had both a myoelectric amputation, whether the amputation had been done on
and a conventional prosthesis, twelve (30 per cent) the side of dominance, or the length of time before the
believed that the myoetectric prosthesis gave superior fitting of a prosthesis. Those who had an occupation that
sensory feedback compared with the conventional pros- required sitting at a desk or supervising others appeared
thesis. Patients described myoelectric feedback as either to use the myoelectric prosthesis more than those who
visual (that is, they watched the prosthesis close and performed manual labor or whose occupation made
open), auditory (they listened to the hum of the motor), heavy demands on the prosthesis, but with our sample
or tactile (some patients could “feel” with the pros- size, the difference was not significant (chi-square test
thetic hand). Some patients used the sound of the strain with Yates correction, p 0.4). Those who had lost the
of the motor to determine when an object was held extremity in military service or in a motor-vehicle acci-
adequately. Only eight patients (20 per cent) believed dent appeared to use the prosthesis more often than
that the conventional unit gave superior sensory feed- those who had had an amputation because of a work-
back. Three patients (8 per cent) thought that the pros- related accident, but again the difference was not signif-
theses were the same with regard to feedback, and icant (chi-square test with Yates correction, p 0.3). Of
seventeen (43 per cent) had not experienced feedback the two patients who had had a congenital amputation,
from any prosthesis. one had totally rejected the prosthesis and the other

VOL. 75-A, NO. 12. DECEMBER 1993

1788 D. H. SILCOX. III. M. D. ROOKS. R. R. VOGEL. AND L. L. FLEMING

TABLE V
RESULTS OF FOLLOW-UP STUDIES OF MYOELECTRIC PROSTHESES

No. of Duration of Age (Yrs.) Rate of

Study Year Patients Follow-up Mean Range Rejection
(Yrs.) (Per cent)

Northmore-Ball et al. 1980 43 16 mos. 36 20-57 8

Herberts et al. 1980 16 2-4 Not available 19-77 44
Stein and Walley 1983 20 1-4 Not available Not available <40
Hegeretal. 1985 164 3 39 18-70 22
Dalsey et al. 1989 20 2-5 Not available 19-67 0
Present study 1993 44 5 38 6-69 50

used the myoelectric unit 5 per cent of the time at home and found that the rate of acceptance was 90 per cent
and at work. with an average follow-up time of approximately three
We were not able to show any significant association years2. These results suggest that patients may use the
between the age of the patient at the time of fitting of myoelectric prosthesis less with time as they develop
the myoelectric prosthesis and usage of the prosthesis more convenient methods of taking care of their needs.
(regression analysis, p 0.94). We divided the patients Stein and Walley reported, in 1983, that in a group
into groups on the basis of age, according to decade of patients who also owned a conventional prosthesis,
( that is, one to ten years old, eleven to twenty years old, 60 per cent preferred the myoelectric prosthesis. In our
and so on), at the time of the fitting and found no trend study, 50 per cent of the patients who owned two pros-
for prosthetic usage (Spearman rank-order test and theses preferred the conventional prosthesis and 33 per
Mann-Whitney U test). cent preferred the myoelectric unit. This may indicate a
Three of the eight female patients rejected all pros- trend for greater acceptance of the conventional pros-
theses, as did six (21 per cent) of the twenty-nine pa- thesis (chi-square analysis with Yates correction, p =

tients who had lost the dominant hand. These numbers 0.16) but, with this small sample size, we could not reach
were too small for us to come to any conclusions about a more definite conclusion.
significance. The numbers were also too small for us to By creating a grading system, we were able to obtain
conclude a difference in utilization with regard to the a more accurate idea of the use of myoelectric and
level of amputation (Table III). conventional prostheses and to clearly define rejection.
Nineteen patients (43 per cent) stated that one of Previous reports3’4’8 did not define rejection and, in some
the main reasons that they wore the myoelectric unit studies, infrequent use was considered to be rejection. If
was its appearance (Table IV). One patient had an ex- we had considered poor use of the myoelectric prosthe-
cellent utilization score even though the motor had been ses to be rejection of the prostheses, then the rate of
broken for a year, because she liked the appearance of rejection of myoelectric prostheses in this study would
the device. have been 64 per cent. Similarly, if poor use of the
There was a variety of reasons why the myoelectric conventional prostheses had been considered to be
unit was not used. Sixteen patients (36 per cent) re- rejection of the prostheses, the rate of rejection of
sponded that it was too heavy; ten (23 per cent), that the conventional prostheses in this study would have been
prosthesis was too slow; and nine (20 per cen), that it 63 per cent; these percentages are approximately the
was not durable enough (Table IV). same and are similar to established rates of rejection of
upper-extremity prostheses by patients who have had an
Discussion above-the-elbow or below-the-elbow amputation’.
As the cost of medical care steadily increases, the We found cosmetic appearance to be the most com-
cost-benefit ratio of treatment is coming under great monly cited reason for use of a myoelectric prosthesis.
scrutiny. Upper-extremity myoelectric prostheses are Some physicians argue that this is not a valid reason for
relatively expensive ($10,000 to $40,000) compared with the prescription of a myoelectric prosthesis, and we con-
their conventional counterparts ($2000 to $5000). In ad- cur. Cosmetic appearance may be the reason why a
dition to the higher initial cost of myoelectric prosthe- patient uses the myoelectric prosthesis socially, and thus
ses, the costs of fitting, training, and maintenance are one could argue that social use should not be included
also higher. in the utilization grading. However, in the interest of
The rate of rejection of myoelectric prostheses has determining where and why a patient uses the prosthe-
been reported to be 0 to 44 per cent’34’9 (Table V). The sis, we did include it. When social use was excluded, we
present study, however, which had a longer duration of found that two patients used the myoetectric unit for
follow-up than those studies, showed a 50 per cent rate social situations only, and thus the rate of rejection rose
of rejection. In 1979, one of us (L. L. F.) reported the to 55 per cent (twenty-four of forty-four patients). One
results in a subset of the patients in the present study patient used the conventional prosthesis for social situ-

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 MYOELECTRIC PROSTHESES 1789

ations only, thus increasing the rate of rejection of con- conventional prostheses. This finding differs from our
ventional prostheses to 35 per cent (fourteen of forty previous experience7.
patients). A previous report4 suggested that a myoelectric pros-
While our sample size was too small to demonstrate thesis provides no sensory feedback and that users
a significant difference, previous studies have shown an depend entirely on vision for control, while some feed-
association of use of a myoelectric prosthesis with type back is possible with a conventional prosthesis. Other
of occupation8”, and our data by no means contradict reports67 have disagreed. Thirty-three per cent of the
the concept that a person who works at a desk or per- patients in a series reported by Kritter were certain that
forms light activities is more likely to accept a myoelec- they had more feedback from the myoelectric unit than
tric prosthesis than one who is engaged in manual labor. from the conventional prosthesis, and our results agree
Training by an occupational therapist in the proper use closely (32 per cent thought that the myoelectric device
of a myoelectric prosthesis did not improve the utiliza- provided better feedback). However, we did not find
tion of the prosthesis. The time between the amputation an association between the belief that feedback was bet-
and the fitting of the prosthesis also appeared to make ter with the myoelectric unit and better usage of the
no difference in the rate of acceptance of myoelectric or prosthesis.

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VOL. 75.A, NO. 12. DECEMBER 1993