Your Experience Matters

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Your willingness to share helps us improve. Thank you for your consideration.

The following questions are for people with upper extremity limb loss and/or limb difference.
Your email is requested, but not required.
Answers will be used to improve prosthetic innovations and education.
We appreciate your time and are grateful for your participation.
If you have any questions please contact us at MarinsMed.com

Level of upper body limb loss or limb difference?

Partial Hand

At the Wrist

Below the Elbow

At the Elbow

Above the Elbow

At the Shoulder

Above the Shoulder

Bilateral

Is your limb loss or limb difference congenital or a result of trauma/injury or disease?

Congenital

Trauma or Injury

Disease

How long have you lived with your most recent limb loss or limb difference?

Less than 2 years

Between 2 and 10 years

More than 10 years

Clear selection

Do you have a prosthetic?

Yes

Clear selection

If yes, which devices do you have?

Body-Powered

Myoelectric/Bionic/Robotic

Passive

Hybrid

None

How long did it take for you to achieve proficiency with your current prosthetic?

Days

Weeks

Months

Years

Other:

Clear selection

If you have a myoelectric/bionic device, were you required to use a body-powered device first?

Yes

Not Applicable

Clear selection

If you have a prosthetic, how often do you use it?

Everyday

Most Days

Occasionally

Never

Clear selection

On a scale of 1 to 5, 1 being sedentary and 5 being very active rate your activity level.

Sedentary

Active

Clear selection

If you have a prosthetic, how did you select your device?

Personal research

Guidance from a doctor

Guidance from a prosthetist

Social Media Influence

Friends or Family Suggestion

Television

Other:

How informed did you feel?

Uninformed

Well informed

Clear selection

If you have a body-powered prosthetic, what is the grasping method of the device?

Voluntary Opening (VO or rubber band)

Voluntary Closing (VC)

Not certain

How important is cost/insurance in determining your device selection?

Not Important

Very Important

Clear selection

Do you believe an auto-locking and auto-unlocking grasp device would improve its function?

Yes

Uncertain

Clear selection

Do you believe an auto-locking and auto-unlocking grasp device would reduce fatigue?

Yes

Uncertain

Clear selection

What are the problematic issues with your current device, if any? (Please identify the device if possible.)

Submit

Clear form

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