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Competitive Motivation Increases Use of Prosthetic Limbs — study

    Prosthetic devices are meant to improve the quality of life of people with limb loss. But effective use of these devices is only possible after proper training, which requires time and commitment beyond the clinic. However, for some individuals, there’s not enough motivation to train, so prosthetic limb rejection has become common.

    Researchers found that competitive motivation increases use of prosthetic limbs.

    In the case of myoelectric prosthetic limbs, expectations run high, but their function is still far from being comparable to a biological limb. Electric motors power myoelectric prostheses, and rejection rates for these devices are reportedly as high as 40%.

    Although technologies like osseointegration and implantable sensors can address many of these challenges, without the proper training, existing prosthetic hands still cannot provide the ease of biological limbs. This led researchers to investigate how to motivate individuals by tapping into their competitive side.

    What is Cybathlon?  

    The mission for the first edition of the Cybathlon in 2016 was to improve public awareness of physical disabilities and assistive technologies, including prosthetic arms. The event adopted a competition format that would drive research teams worldwide to explore users’ needs and develop new solutions.

    Since the 2016 Cybathlon, researchers have found many prosthetic developments from an engineering perspective. However, these solutions still require the user’s learning, adaptation, and practice.

    Occupational rehabilitation and physical therapy typically facilitate the learning process. However, different people are motivated by various factors, including cooperative gaming and competition. Jumping from this observation, the researchers investigated if training for and participating in a competitive event, like Cybathlon 2020, could promote behavioral changes in an individual with upper limb amputation.

    Behavioral change was defined as the participant’s active time while wearing the prosthetic limb and the ability to modulate movement speeds. To track these changes, the researchers studied extensive home-use data from before, during, and after Cybathlon 2020.

    The study participant  

    The researchers recruited a 53-year-old male with an upper-elbow amputation on the left arm. He uses a neuromusculoskeletal prosthetic arm and has undergone nerve transfers for intuitive myoelectric control. The myoelectric prosthesis setup included an Artificial Limb Controller from osseointegration-specialist Integrum AB as well as a Greifer prosthetic hand and 12K50 elbow from Ottobock.  

    To monitor at-home prosthesis use, the researchers used a real time logger that automatically stored prosthetic use data on an SD card. The participant used the same prosthetic arm to train for the competition and at home, so the researchers tracked his device use throughout and after the training phase.  

    Training for Cybathlon 2020   

    After receiving a powered wrist from Ottobock in August 2020, the study participant began his training, mainly consisting of structured repetition of all major tasks included in the Cybathlon Powered Arm Prosthesis category. The research team also enhanced his training program with performance and strategy suggestions.

    Besides his in-lab training sessions, the more significant component of the program was done at home using various training materials and techniques. The participant reportedly spent a lot of time practicing the “cup stacking” task, which required him to stack ten plastic cups in a pyramid as precisely and quickly as possible.

    The participant also reported seeking new ways to use his prosthetic limb in everyday life as a means of training. Some of these tasks—picking up everyday objects, wearing and removing clothing, and tying shoelaces—were also included in the competition.

    Besides these, the participant did random and spontaneous tasks with his artificial limb, like washing dishes and performing car repairs.


    The researchers tracked the participant’s prosthesis use average before, during, and after Cybathlon.

    Before the training period, the participant used his prosthetic arm for an average of 10.98 hours per day. During training, his prosthesis use averaged 5.28 hours per day; after Cybathlon, it averaged 11.34 hours per day.

    In the post-Cybathlon phase, the participant’s daily active use of his prosthetic arm has dropped to 7.67 minutes — lower than during the training phase but still 65.7% higher than pre-Cybathlon.

    Feedback from the study participant  

    In September 2021, six months after the post-Cybathlon phase, the study participant reported that he had doubled his prosthetic arm use at home compared to the pre-training period. He told the researchers that there was an improvement in his speed modulation when controlling his prosthetic device. He also learned and routinely performed new movements, like wrist rotation, in the prosthetic limb at home.

    Notably, the researchers have confirmed that the participant’s perception of his prosthetic arm and its functionality has improved. Furthermore, he continues to perform everyday activities learned during the Cybathlon, which has given the participant more independence.

    The bottom line  

    This study has shown that individuals motivated by competition can work toward better usage of their prosthetic devices. The researchers have determined that a competitive event like Cybathlon can promote behavioral changes, particularly in how some individuals with limb loss use their prosthetic limbs. Daily activities can become opportunities for training, improving prosthetic limb function, and reducing rejection rates.

    If you are motivated by competition, you may want to discuss a gamified training program with your physical therapist, rehabilitation team, and prosthetist.