Quantitative Eye Gaze and Movement Differences in Visuomotor Adaptations to Varying Task Demands Among Upper-Extremity Prosthesis Users
Authors: Jacqueline S. Hebert, Quinn A. Boser, Aïda M. Valevicius, Hiroki Tanikawa, Ewen B. Lavoie, Albert H. Vette, Patrick M. Pilarski, Craig S. Chapman
Journal: JAMA Network Open (2019)

<h3>Importance</h3> New treatments for upper-limb amputation aim to improve movement quality and reduce visual attention to the prosthesis. However, evaluation is limited by a lack of understanding of the essential features of human-prosthesis behavior and by an absence of consistent task protocols. <h3>Objective</h3> To evaluate whether task selection is a factor in visuomotor adaptations by prosthesis users to accomplish 2 tasks easily performed by individuals with normal arm function. <h3>Design, Setting, and Participants</h3> This cross-sectional study was conducted in a single research center at the University of Alberta, Edmonton, Alberta, Canada. Upper-extremity prosthesis users were recruited from January 1, 2016, through December 31, 2016, and individuals with normal arm function were recruited from October 1, 2015, through November 30, 2015. Eight prosthesis users and 16 participants with normal arm function were asked to perform 2 goal-directed tasks with synchronized motion capture and eye tracking. Data analysis was performed from December 3, 2018, to April 15, 2019. <h3>Main Outcome and Measures</h3> Movement time, eye fixation, and range of motion of the upper body during 2 object transfer tasks (cup and box) were the main outcomes. <h3>Results</h3> A convenience sample comprised 8 male prosthesis users with acquired amputation (mean [range] age, 45 [30-64] years), along with 16 participants with normal arm function (8 [50%] of whom were men; mean [range] age, 26 [18-43] years; mean [range] height, 172.3 [158.0-186.0] cm; all right handed). Prosthesis users spent a disproportionately prolonged mean (SD) time in grasp and release phases when handling the cups (grasp: 2.0 [2.3] seconds vs 0.9 [0.8] seconds;<i>P</i> &lt; .001; release: 1.1 [0.6] seconds vs 0.7 [0.4] seconds;<i>P</i> &lt; .001). Prosthesis users also had increased mean (SD) visual fixations on the hand for the cup compared with the box task during reach (10.2% [12.1%] vs 2.2% [2.8%]) and transport (37.1% [9.7%] vs 22.3% [7.6%]). Fixations on the hand for both tasks were significantly greater for prosthesis users compared with normative values. Prosthesis users had significantly more trunk flexion and extension for the box task compared with the cup task (mean [SD] trunk range of motion, 32.1 [10.7] degrees vs 21.2 [3.7] degrees;<i>P</i> = .01), with all trunk motions greater than normative values. The box task required greater shoulder movements compared with the cup task for prosthesis users (mean [SD] flexion and extension; 51.3 [12.6] degrees vs 41.0 [9.4] degrees,<i>P</i> = .01; abduction and adduction: 40.5 [7.2] degrees vs 32.3 [5.1] degrees,<i>P</i> = .02; rotation: 50.6 [15.7] degrees vs 35.5 [10.0] degrees,<i>P</i> = .02). However, other than shoulder abduction and adduction for the box task, these values were less than those seen for participants with normal arm function. <h3>Conclusions and Relevance</h3> This study suggests that prosthesis users have an inherently different way of adapting to varying task demands, therefore suggesting that task selection is crucial in evaluating visuomotor performance. The cup task required greater compensatory visual fixations and prolonged grasp and release movements, and the box task required specific kinematic compensatory strategies as well as increased visual fixation. This is the first study to date to examine visuomotor differences in prosthesis users across varying task demands, and the findings appear to highlight the advantages of quantitative assessment in understanding human-prosthesis interaction.