The safety of one-stage versus two-stage approach to osseointegrated prosthesis for limb amputation.

Aims: Safety concerns surrounding osseointegration are a significant barrier to replacing socket prosthesis as the standard of care following limb amputation. While implanted osseointegrated prostheses traditionally occur in two stages, a one-stage approach has emerged. Currently, there is no existing comparison of the outcomes of these different approaches. To address safety concerns, this study sought to determine whether a one-stage osseointegration procedure is associated with fewer adverse events than the two-staged approach. Methods: A comprehensive electronic search and quantitative data analysis from eligible studies were performed. Inclusion criteria were adults with a limb amputation managed with a one- or two-stage osseointegration procedure with follow-up reporting of complications. Results: A total of 19 studies were included: four one-stage, 14 two-stage, and one article with both one- and two-stage groups. Superficial infection was the most common complication (one-stage: 38% vs two-stage: 52%). There was a notable difference in the incidence of osteomyelitis (one-stage: nil vs two-stage: 10%) and implant failure (one-stage: 1% vs two-stage: 9%). Fracture incidence was equivocal (one-stage: 13% vs two-stage: 12%), and comparison of soft-tissue, stoma, and mechanical related complications was not possible. Conclusion: This review suggests that the one-stage approach is favourable compared to the two-stage, because the incidence of complications was slightly lower in the one-stage cohort, with a pertinent difference in the incidence of osteomyelitis and implant failure.

The influence of robotic guidance on error detection and correction mechanisms.

New technologies have expanded the available methods to help individuals learn or re-learn motor skills. Despite equivocal evidence for the impact of robotic guidance for motor skill acquisition (Marchal-Crespo, McHughen, Cramer, & Reinkensmeyer, 2010), we have recently shown that robotic guidance mixed with unassisted practice can significantly improve the learning of a golf putting task (Bested & Tremblay, 2018). To understand the mechanisms associated with this new mixed approach (i.e., unassisted and robot-guided practice) for the learning of a golf putting task, the current study aimed to determine if such mixed practice extends to one's ability to detect errors. Participants completed a pre-test, an acquisition phase, as well as immediate, delayed (24-h), and transfer post-tests. During the pre-test, kinematic data from the putter was converted into highly accurate, consistent, and smooth trajectories delivered by a robot arm. During acquisition, 2 groups performed putts towards 3 different targets with robotic guidance on either 0% or 50% of acquisition trials. Only the 50% guidance group significantly reduced ball endpoint distance and variability, as well as ball endpoint error estimations, between the pre-test and the post-tests (i.e., immediate retention, 24-h retention, and 24-h transfer). The current study showed that allowing one to experience both robotic guidance and unassisted (i.e., errorful) performances enhances one's ability to detect errors, which can explain the beneficial motor learning effects of a mixed practice schedule.

What's your number? The effects of trial order on the one-target advantage.

When moving our upper-limb towards a single target, movement times are typically shorter than when movement to a second target is required. This is known as the one-target advantage. Most studies that have demonstrated the one-target advantage have employed separate trial blocks for the one- and two-segment movements. To test if the presence of the one-target advantage depends on advance knowledge of the number of segments, the present study investigated whether the one-target advantage would emerge under different trial orders/sequences. One- and two-segment responses were organized in blocked (i.e., 1-1-1, 2-2-2), alternating (i.e., 1-2-1-2-1-2), and random (i.e., 1-1-2-1-2-2) trial sequences. Similar to previous studies, where only blocked schedules have typically been utilized, the one-target advantage emerged during the blocked and alternate conditions, but not in the random condition. This finding indicates that the one-target advantage is contingent on participants knowing the number of movement segments prior to stimulus onset.

Better together: Contrasting the hypotheses explaining the one-target advantage.

Movement times are significantly shorter when moving from a start position to a single target, compared to when one has to continue onto a second target (i.e., the one-target advantage [OTA]). To explain this movement time difference, both the movement integration and the movement constraint hypotheses have been proposed. Although both hypotheses have been found to have explanatory power as to why the OTA exists, the support for each has been somewhat equivocal. The current review evaluated the relative support in the literature for these two hypotheses. Ultimately, preferential support for each theoretical explanation was found to be related to the higher indices of difficulty (IDs: Fitts, 1954) employed. That is, studies that included higher IDs (i.e., 6-8 bits) were more likely to provide more support for the movement constraint hypothesis, whereas studies employing lower IDs (i.e., 1-4 bits) were more likely to provide more support for the movement integration hypothesis. When the IDs employed were relatively intermediate (i.e., 5 bits), both hypotheses were mostly supported. Thus, task difficulty is crucial when determining which hypothesis better explains the planning and control of sequential goal-directed movements. Critically, the OTA most likely always involves integration but may also involve constraining if the accuracy demands are sufficiently high.

Amending Ongoing Upper-Limb Reaches: Visual and Proprioceptive Contributions?

In order to maximize the precise completion of voluntary actions, humans can theoretically utilize both visual and proprioceptive information to plan and amend ongoing limb trajectories. Although vision has been thought to be a more dominant sensory modality, research has shown that sensory feedback may be processed as a function of its relevance and reliability. As well, theoretical models of voluntary action have suggested that both vision and proprioception can be used to prepare online trajectory amendments. However, empirical evidence regarding the use of proprioception for online control has come from indirect manipulations from the sensory feedback (i.e., without directly perturbing the afferent information; e.g., visual-proprioceptive mismatch). In order to directly assess the relative contributions of visual and proprioceptive feedback to the online control of voluntary actions, direct perturbations to both vision (i.e., liquid crystal goggles) and proprioception (i.e., tendon vibration) were implemented in two experiments. The first experiment employed the manipulations while participants simply performed a rapid goal-directed movement (30 cm amplitude). Results from this first experiment yielded no significant evidence that proprioceptive feedback contributed to online control processes. The second experiment employed an imperceptible target jump to elicit online trajectory amendments. Without or with tendon vibration, participants still corrected for the target jumps. The current study provided more evidence of the importance of vision for online control but little support for the importance of proprioception for online limb-target regulation mechanisms.