User perspectives on the movement, control, and sensory features of upper limb prosthetic devices: a qualitative cross-case comparison.

Abstract

Options for upper limb prostheses have expanded with advances in control systems and sensory feedback. However, it remains unclear how these features correspond to user outcomes and how they should influence prosthesis selection. This study explored upper limb prosthesis users' perspectives on key functional features of their devices. Sixteen individuals with unilateral upper limb loss and experience using body powered, single or multiple degree-of-freedom myoelectric, or sensory-augmented prostheses participated in semi-structured interviews. A qualitative cross-case analysis was conducted to identify themes related to prosthesis movements, control strategies, and sensory feedback. Participants consistently described the focus required to use their prosthesis as a central factor influencing experiences across device types. Overhead use and complex movements were challenging regardless of device, often requiring preplanning. Control reliability and grasp modulation were critical for confidence and task performance, with naturalness of control improving through practice. When available, sensory feedback enhanced grasp control and embodiment; however, most participants relied primarily on visual feedback, increasing concentration demands. Desired improvements included expanded movements, more reliable control, and enhanced sensory feedback. Findings clarify how functional features shape prosthesis use and provide insight to support user-centered prosthesis selection and rehabilitation planning.