On September 16–17, 2016, the American Academy of Orthotists and Prosthetists convened its 12th State of the Science Conference, with the event largely focused on the various control options and design types for upper-limb prostheses. Using a systematic review commissioned by the Academy and published by Carey et al.1 in 2015, a multinational, multidisciplinary panel was assembled to discuss a range of considerations and perspectives surrounding this topic. These perspectives included those of the clinical prosthetist in the private care setting, rehabilitation clinicians from US Department of Veterans Affairs (VA) and military health care settings, the physiatrist, the occupational therapist, the end user, global observations and trends, engineering, developing technologies, and associated medical procedures and outcome assessment.
A number of observations were brought forward that will receive additional treatment in these proceedings. Chief among them was the trend in the US health care system to approach control options for upper-limb prostheses in a hierarchal fashion. The premise of this approach may be based on the convenience of introducing control options in an order of increasing complexity, beginning with the choice of no prosthesis and proceeding with passive and body-powered designs and culminating in more technologically advanced externally powered options, frequently epitomized by myoelectric and hybrid control. This paradigm has led to a number of inaccurate dispositions. In a private health care system that remains characterized by both “high-end” and “low-end” coverage, any perceived ranking of prosthetic options could be used to exclude access to prosthetic care that is construed as “higher” or “advanced,” in deference to more basic care.