A Critical Review of Functionality Assessment in Natural and Prosthetic Hands

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Abstract
Functionality is a generic term used when considering the dexterity and manipulative ability provided by both natural and artificial hands. Despite this, there has been little standardised work to quantify this terminology, or to allow the performance of a hand prosthesis to be compared to that of the human hand. This paper details, with wide-ranging emphasis, existing hand assessment procedures developed for both clinical and research applications. The absence of conformity in these protocols, along with a reliance on subjective evaluations, produces concerns over their reliability and validity for providing meaningful information on hand performance. The assessment of prosthetic hands has been largely dependent on engineering tests and minimal activities of daily living. An evaluation of these procedures reveals a lack of uniformity and, moreover, an inability to quantify the functionality of such devices with respect to a benchmark, such as the human hand. Conclusions from the critical review of both natural and prosthetic hand assessment procedures are used to provide criteria for a standardised and objective protocol for use in a clinical environment, where emphasis on the collation of tangible and repeatable data is as important as the speed and cost of the procedure.

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