Perceptions of prosthetic attention among lower limb prosthesis users: a focus group study

Abstract

Purpose

Use of a lower limb prosthesis generally requires increased cognitive effort to compensate for missing motor and sensory inputs. This study sought to examine how lower limb prosthesis users perceive paying attention to their prosthesis(es) in daily life.

Materials and methods

Focus groups with lower limb prosthesis users were conducted virtually using semi-structured questions. Verbatim transcripts were excerpted, coded, and reconciled. Inductive thematic analysis was undertaken to identify experiences shared by participants.

Results

Five themes emerged from five focus groups conducted with thirty individuals: Paying attention to my prosthesis is just what I have to do; I pay attention to how my prosthetic socket fits and feels every day; I pay attention because I don’t want to fall; I pay attention because I have to learn to do things in a new way; and If I can trust that my prosthesis will do what I want, I can pay less attention to it.

Conclusions

Prosthetic attention, including both background and foreground attention, is a shared experience among lower limb prosthesis users. The amount and frequency of prosthetic attention fluctuates throughout the day and changes over time. Measuring attention could inform the evaluation and prescription of technology intended to reduce cognitive effort.

IMPLICATIONS FOR REHABILITATION

• Walking or performing mobility tasks with a prosthesis requires increased attention and may limit the cognitive resources available for other important activities.

• Lower limb prosthesis users report paying attention to their prosthesis(ses) to avoid falling, to maintain the fit of their prosthetic socket, and to learn to complete mobility tasks with a prosthesis.

• Clinicians should discuss prosthetic attention with new prosthesis users and explain how it is expected to decrease over time.

• Prosthetic technology may affect prosthetic attention but development of a measure to assess prosthetic attention is needed to accurately evaluate this relationship.

Keywords:

• Artificial limbs
• amputation
• focus groups
• rehabilitation
• mobility limitation
• attention

Acknowledgements

The authors wish to acknowledge Dr. Shane Wurdeman and Hanger Clinics for their assistance with participant recruitment. The authors wish to acknowledge Rana Salem for developing and managing the REDCap database and cleaning and analysing intake survey data. The authors also wish to acknowledge Dana Wilkie, Alexandra Hinson, and Tiffany Amos for screening participants, scheduling focus groups, and assisting participants to join the focus groups.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the U.S. Department of Defense Orthotics and Prosthetics Outcomes Research Program (Grant/Award Number: W81XWH2110169).