Introducing an adjustable upper limb prosthesis into a Ugandan clinical service: impacts on free living behaviour and prosthetic use
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Date
2025-04-04
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Publisher
Nature Publishing Group UK
Abstract
Access to prosthetic services in Uganda is poor, negatively impacting people with upper limb difference
in function, community participation, and employment. Technologies to improve the efficiency and
effectiveness of services are needed, but there is very little evidence of potential solutions. Off-theshelf, adjustable prosthetic sockets, which can be fitted in minimal time without the complexities
associated with traditional socket manufacturing, show promise. We tested the feasibility of
introducing the Koalaa ALX, a prosthesis for people with trans-radial limb difference, and a peerto-peer support system into a Ugandan clinical service. Prosthesis-worn and thigh-worn monitors
successfully captured concurrent patterns of wear and free-living physical behaviours (including periods
at home and away) at baseline, post-fitting, and six months post-fitting. End-of-study interviews
captured participants’ experiences. Four of the eight participants had no previous experience using
a prosthesis (new users). The ALX could be easily deployed and supported. All participants wore
their ALX, with an increase in wear time among new users at six months. Prosthesis donning and
doffing events were associated with behavioural changes (e.g., changes in stepping duration). The
interviews revealed good levels of satisfaction, though concerns about access to repairs, cleaning, heat
discomfort, and long-term support were noted.
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Citation
Pickard, N., B. Mulindwa, L. Gracey-McMinn, et al. 'Introducing an Adjustable Upper Limb Prosthesis into a Ugandan Clinical Service: Impacts on Free Living Behaviour and Prosthetic use', Scientific Reports, vol. 15/no. 1, (2025), pp. 11585.