Prosthetic Device Sensory Feedback Evaluation Form
Please provide your feedback on how your prosthetic device feels and performs during daily activities.
Your Name (optional)
Type of Prosthetic Device
*
Please Select
Upper limb prosthesis
Lower limb prosthesis
Hand prosthesis
Foot prosthesis
Other
How long have you been using this device?
*
Please Select
Less than 1 month
1-6 months
6-12 months
More than 1 year
Overall comfort of the device
*
1
2
3
4
5
How natural does the sensory feedback feel?
*
Not natural at all
1
2
3
4
Extremely natural
5
1 is Not natural at all, 5 is Extremely natural
Reliability of the sensory feedback
*
Very unreliable
1
2
3
4
Very reliable
5
1 is Very unreliable, 5 is Very reliable
Ease of use in daily activities
*
Very difficult
1
2
3
4
Very easy
5
1 is Very difficult, 5 is Very easy
Has the device improved your ability to perform daily tasks?
*
Significantly improved
Somewhat improved
No change
Somewhat worsened
Significantly worsened
Have you experienced any issues or discomfort?
*
No issues
Minor issues
Major issues
Additional comments or suggestions
Submit Evaluation
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