The purpose of this literature review was to identify any adaptations that could be made to the rehabilitation process for Traumatic Transfemoral Amputees. Traumatic Transfemoral Amputation is particularly debilitating with the amputees encountering many obstacles throughout the rehabilitation process. These obstacles can prevent the return to pre-morbid functioning. With an ever-increasing number of amputees within the United States, it is imperative the rehabilitation process be addressed. This literature review addresses possible adjustments in the initial stages of rehabilitation examining the post-operative, pre-prosthetic, and prosthetic rehabilitation stage to enhance the physical functioning for the amputee. This comprehensive literature review encompassing 63 academic and medical journals analyzes the research literature regarding each of the three stages of the post-operative procedure. The literature review synthesizes the research findings to see how procedures may be adapted to reduce the risk of further co-morbidities such as loss of bone mineral density and disuse atrophy. Loss of bone mineral density and disuse atrophy are the major contributing factors to the amputees decreased mobility. Reducing this loss can be addressed within the initial post-operative, pre-prosthetic, and prosthetic rehabilitation stages. Further research is required to examine the efficacy of these alterations in relation to this specific population.

No description available.

Knee osteoarthritis (OA) is a debilitating disease affecting the entire knee joint by inducing pathological changes to the cartilage and menisci. Currently, the etiology of OA is not completely understood. However, altered gait mechanics, specifically increased joint loading, of OA patients have a clear association with both symptomatic and structural OA progression. Non-surgical intervention tools, such as variable stiffness shoes (VSS), have been developed as a way to decrease loading within the knee joint. However, with external moments being surrogate measures for knee loading, it is unclear if changes in knee moments with the footwear are sufficient to result in a clinical benefit. Therefore, this project’s purpose was to investigate whether a VSS intervention can alter knee joint loading and menisci function in a knee OA population. We used gait analysis, musculoskeletal modeling, and finite element (FE) analysis to determine the effect of VSS on gait mechanics, knee joint contact force, and menisci stress and strain, compared to a control shoe. We found knee moments did not decrease with the VSS intervention. Furthermore, participants who did experience a decrease in knee adduction moment did not always experience a decrease in medial compartment contact force. However, results from our FE modeling of the tibiofemoral joint indicate significant changes in knee joint contact force can influence stress placed on the menisci. Results from this study suggest knee contact forces and tissue stress, not only external moments, should be considered when investigating if VSS can positively impact an OA population.

Various silicone elastomers have been evaluated for use in the prosthetic reconstruction of facial defects. Their strength, texture, flexibility, hardness, ease of preparation, pigment receptivity and retention, and their resistance to cleaning were compared and the data consulted when an elastomer was chosen to restore defects, improve aesthetics and reestablish the confidence of a selection of patients. Detailed case reports are provided, together with information on the adhesives or mechanical methods available for retaining the facial prosetheses. Cyanoacrylate adhesives for use on skin surfaces and as tissue adhesives have been studied in detail. A novel n-butyl 413 cyanoacrylate has been developed with a viscosity, haemostatic property and stability to make it particularly suitable for use in skin grafting and tissue repair. It has already been used with good results on patients with severe burns. An improved formulation, containing a fluorescent dye, can be precisely applied through a specially constructed foot-controlled dispenser illuminated by a fibre-optic supplying UV-light. Cyanoacrylates are already being used as tissue adhesives in place of the conventional but potentially disfiguring suture. The availability of improved, imperceptible adhesives and a precision applicator, which can be used in a modern operating theatre, will extend their effectiveness and satisfy some of the needs of Plastic, and Oral and Maxillo-Facial Surgeons. Portable applicators have potential use in battlefield and in veterinary surgery and overcome the imprecision characteristic of earlier methods.

The aim of this study was to describe non-surgical treatment options for the diseases mucositis and peri-implantitis found in present literature. The literature review also illustrates the effect of the treatment opptions on soft tissue with mucositis and peri-implantitis surrounding dental implants. The study reviews twelve scientific articles that have been processed from the aim of the study. The result shows six therapy options, Er:YAG laser, air abrasive, ultrasonic device, hand instruments, hand instruments in combination with antibiotics and hand instruments in combination with clorhexidin. The following methods are described according to how they are used and how they affect the soft tissue surrounding dental implants. The therapy options showed some improvements with reduced pocket depth, bleeding on probing (BOP) and gain in clinical attachment level (CAL). Several studies accentuate the importance of good self-care and regular visits for supportive care which have an impact on the survival of the implants and in avoiding progress of disease. All of the therapy options have positive effects but to different extent and it is not concluded how long the positive effect remains in the soft tissue. / Syftet var att redogöra för icke-kirurgiska behandlingsmetoder vid mukosit och periimplantitsom beskrivs i litteraturen. Litteraturstudien belyser ävenbehandlingsalternativens påverkan på vävnaden vid sjukdomstillstånden mukosit ochperi-implantit. Studien är utförd som en allmän litteraturstudie och innefattar 12vetenskapliga artiklar som bearbetats utefter studiens syfte. Resultatet redovisar sexbehandlingsalternativ, Er:YAG laser, air abrasive, ultraljud, handinstrument,handinstrument i kombination med antibiotika och handinstrument i kombination medklorhexidin. Metoderna är beskrivna både hur de används och vilken klinisk påverkan dehar på vävnaden runt tandimplantat. De förbättringar som visats är viss reduktion avfickdjup, blödning vid sondering (BOP) och vinst av klinisk fästenivå (CAL). Samtligametoder ger positiv effekt, men i olika grad. Ett flertal studier påvisar betydelsen av godegenvård och regelbundna besök för stödbehandling vilket är av betydelse förimplantatens överlevnad och för att undvika progression av sjukdom. Däremot kan detses en begränsning i hur länge resultatet bibehålls i vävnaden.

Motor control of any movement task involves the integration of neural, muscular and skeletal systems. This integration must occur throughout the sensorimotor system and focus its efforts on controlling the system endpoint, e.g. the foot during locomotion. A person with a uni-lateral trans-tibial amputation has lost the foot, ankle joint, and muscles crossing those joints, hence the residuum becomes the new terminus of the motor system. The amputee must now adjust to the additional challenges of utilizing a compromised motor system as well as the challenges of controlling an external device, i.e. prosthesis, through the mechanical interface between the residuum and prosthetic socket. The obvious physical and physiologic asymmetries between the sound and amputated limbs are also involved in strategies for locomotion involving kinematic and kinetic asymmetries (Winter&Sienko, 1988). There are many questions as to why these asymmetric locomotor strategies are selected and what factors may be influencing that strategy. Factors influencing a change in locomotor strategy could be related to 1) the central nervous system accounting for the loss of sensorimotor feedback, 2) the altered mechanics of this new human/prosthetic system, or some combination of these factors. Understanding how the human motor system adjusts to the amputation and to the addition of an external mechanical device can provide useful insight into how robust the human control system may be and to adaptations in human motor control. This research uses a group of individuals with a uni-lateral trans-tibial amputation and a group of intact individuals using an Ankle Foot Orthosis (AFO) performing a cycling task to understand the "motor adjustments" necessary to utilize an external device for locomotion. Results of these experiments suggest 1) the motor system does account for the activation-contraction dynamics when coordinating muscle activity post amputation, 2) the motor system also changes joint kinetics and muscle activity, 3) these changes are related to control of the interface between the limb and the external device, and 4) the motor system does not alter kinetic asymmetries when kinematic asymmetries are minimized, contrary to a common practice in rehabilitation (Kapp, 2004). Results suggest that control of the external device, i.e. prosthesis or AFO, via the interface between the limb and the device reflect "motor adjustments" made by the nervous system and may be viewed in the context of tool use. Clinical goals in rehabilitation currently focus on minimizing gait deviations whereas the clinical application of these results suggest these deviations from normal locomotion are motor adjustments necessary to control a tool, i.e. prosthesis, by the motor system. Examining amputee locomotion in the context of tool use changes the clinical paradigm from one designed to minimize deviations to one intended to understand this behavior as related to interface control of the device thereby shifting the focus to improving function of the limb/prosthesis system. Kapp SL. (2004) Atlas amp limb def: surg pros rehab princ. 3rd ed: 385 - 394. Winter&Sienko. (1988) J Biomech, 21: 361 - 367.

This work focuses on the use of 3D motion capture data to create and optimize a robotic human body model (RHBM) to predict the inverse kinematics of the upper body. The RHBM is a 25 degrees of freedom (DoFs) upper body model with subject specific kinematic parameters. The model was developed to predict the inverse kinematics of the upper body in the simulation of a virtual person, including persons with functional limitations such as a transradial or transhumeral amputation. Motion data were collected from 14 subjects: 10 non-amputees control subjects, 1 person with a transradial amputation, and 3 persons with a transhumeral amputation, in the University of South Florida's (USF) motion analysis laboratory. Motion capture for each subject consisted of the repetition of a series of range of motion (RoM) tasks and activities of daily living (ADLs), which were recorded using an eight camera Vicon (Oxford, UK) motion analysis system. The control subjects were also asked to repeat the motions while wearing a brace on their dominant arm. The RoM tasks consisted of elbow flexion & extension, forearm pronation & supination, shoulder flexion & extension, shoulder abduction & adduction, shoulder rotation, torso flexion & extension, torso lateral flexion, and torso rotation. The ADLs evaluated were brushing one's hair, drinking from a cup, eating with a knife and fork, lifting a laundry basket, and opening a door. The impact of bracing and prosthetic devices on the subjects' RoM, and their motion during ADLs was analyzed. The segment geometries of the subjects' upper body were extracted directly from the motion analysis data using a functional joint center method. With this method there are no conventional or segment length differences between recorded data segments and the RHBM. This ensures the accuracy of the RHBM when reconstructing a recorded task, as the model has the same geometry as the recorded data. A detailed investigation of the weighted least norm, probability density gradient projection method, artificial neural networks was performed to optimize the redundancy RHBM inverse kinematics. The selected control algorithm consisted of a combination of the weighted least norm method and the gradient projection of the null space, minimizing the inverse of the probability density function. This method increases the accuracy of the RHBM while being suitable for a wide range of tasks and observing the required subject constraint inputs.

No description available.

Background Recent conflicts have seen an increase in trauma related military amputees who incur complex injuries which result in varied residual limbs. In many cases these amputees have been provided with state of the art (SOTA) components with the expectation that they will transfer into NHS care after military discharge. However, there is a lack of knowledge around how prosthetic prescriptions are made in both the MOD and NHS, including patient involvement. It is important to explore prosthetic prescription decisions to enhance the quality, consistency and equity of care delivery for trauma amputees. This thesis explores decision making in prosthetic care for trauma amputees in the UK during this period of change. Aims To explore aspects of prosthetic care provision in the UK including clinical decision making, patient experience and the transition of prosthetic care from the MOD to the NHS. Design An exploratory qualitative project informed by decision making and patient involvement theory. Semi-structured interviews were carried out with nineteen clinical staff involved in prosthetic provision, six civilian and five veteran trauma amputees. Thematic analysis was used to analyse the data. Findings Prosthetists used a wide range of factors in making prescription decisions, including physical characteristics, patients’ goals, and predicted activity levels. Prescription decision making varied depending on the prosthetists’ level of experience and the different ‘cues’ identified. In some cases there was a lack of transparency about drivers for the prescription choice. Prescription decisions are influenced by long term relationships between prosthetist and patient, allowing a trial and error approach with increasing patient involvement over time. Patient experiences of their trauma amputation influenced their approach to rehabilitation. Patients reported wanting different levels of involvement in their prosthetic care, however, communication was essential for all. Veteran amputees benefited from peer support opportunities which NHS services were less conducive to. However, NHS amputees were more likely to have been ‘involved’ in care decisions. The expectations that MOD patients had of inferior care in the NHS were not realised in the majority of veteran cases. Recommendations Research is needed to support prosthetists’ decisions to become more consistent and transparent. The NHS should consider introducing a peer support model for trauma patients, and particularly in the early stages of rehabilitation.

The topic of this master’s thesis is design of human leg prosthesis for children. The thesis concerns own design of transbinal prosthesis for children that meet the basic technical, ergonomical and social requi¬rements and also brings a new look and shape as solution to the main topic. The infant incubator is designed in regard to modern materials and technologies.