Control within a virtual environment is correlated to functional outcomes when using a physical prosthesis

BACKGROUND: Advances such as targeted muscle reinnervation and pattern recognition control may provide improved control of upper limb myoelectric prostheses, but evaluating user function remains challenging. Virtual environments are cost-effective and immersive tools that are increasingly used to provide practice and evaluate prosthesis control, but the relationship between virtual and physical outcomes—i.e., whether practice in a virtual environment translates to improved physical performance—is not understood. METHODS: Nine people with transhumeral amputations who previously had targeted muscle reinnervation surgery were fitted with a myoelectric prosthesis comprising a commercially available elbow, wrist, terminal device, and pattern recognition control system. Virtual and physical outcome measures were obtained before and after a 6-week home trial of the prosthesis. RESULTS: After the home trial, subjects showed statistically significant improvements (p < 0.05) in offline classification error, the virtual Target Achievement Control test, and the physical Southampton Hand Assessment Procedure and Box and Blocks Test. A trend toward improvement was also observed in the physical Clothespin Relocation task and Jebsen-Taylor test; however, these changes were not statistically significant. The median completion time in the virtual test correlated strongly and significantly with the Southampton Hand Assessment Procedure (p = 0.05, R = − 0.86), Box and Blocks Test (p = 0.007, R = − 0.82), Jebsen-Taylor Test (p = 0.003, R = 0.87), and the Assessment of Capacity for Myoelectric Control (p = 0.005,R = − 0.85). The classification error performance only had a significant correlation with the Clothespin Relocation Test (p = 0.018, R = .76). CONCLUSIONS: In-home practice with a pattern recognition-controlled prosthesis improves functional control, as measured by both virtual and physical outcome measures. However, virtual measures need to be validated and standardized to ensure reliability in a clinical or research setting. TRIAL REGISTRATION: This is a registered clinical trial: NCT03097978.