Thesis (M.Sc.(Physiotherapy)), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Background: The impact of non-traumatic lower limb amputation on participant’s quality of life (QOL) is unknown. In an effort to provide better care for people with lower limb amputation, there is a need to first know the impact of this body changing operation on people’s quality of life. Aim of the study: To determine the impact of lower limb amputation on QOL in people in the Johannesburg metropolitan area during their reintegration to their society/community of origin. Objectives: 1. To establish the pre-operative and post-operative:  QOL of participants (including the feelings, experiences and impact of lower limb amputation during the time when they have returned home and to the community).  The functional status of participants.  Household economic and social status of these participants. 2. To establish factors influencing QOL. Methods: A longitudinal pre (amputation) test –post (amputation) test study utilized a combination of interviews to collect quantitative data and in-depth semistructured interviews to gather qualitative data. Consecutive sampling was used to draw participants (n=73) for the interviews at the study sites pre-operatively. The three study sites were Chris Hani Baragwanath Hospital, Charlotte Maxeke Johannesburg General Hospital and Helen Joseph Hospital. Participants were then followed up three months later for post-operative interviews and key informants were selected for in-depth interviews (n=12). Inclusion criteria: Participants were included if they were scheduled for first time unilateral (or bilateral amputation done at the same time) lower limb amputation. The participants were between the ages of 36-71 years. Exclusion criteria: Participants who had an amputation as a result of traumatic or congenital birth defects were excluded from the study. Participants with comorbidities that interfered with function pre-operatively were not included. Procedures: Ethics: Ethical clearance was obtained from the Committee for Research on Human Subjects at the University of the Witwatersrand and permission was obtained from the above hospitals. Participants gave consent before taking part in the study. Instrumentation: A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI), the Barthel Index (BI) and semi-structured in-depth interviews were used. Data collection: Participants were approached before the operation for their preoperative interviews using the above questionnaires and then followed up postoperatively using the same questionnaires and some were selected to participate in semi-structured in-depth interviews three months later. Pilot study: The demographics questionnaire and the modified HESSI were piloted to ensure validity and reliability. iii Data analysis: Data were analyzed using the SPSS Version 17.0 and STATA 10.0. The significance of the study was set at p=0.05. All continuous data are presented as means, medians, standard deviations and confidence intervals (CI 95%). Categorical data are presented as frequencies. Pre and post operative differences were analyzed using Wilcoxon Signed-rank test. A median regression analysis (both the univariate and multivariate regression) was done to establish factors influencing QOL. Pre and post operative differences in the EQ-5D items and the BI items were analyzed using Chi square/Fischer’s exact depending on the data. Data were pooled for presentation as statistical figures in tables. Both an intension to treat analysis and per protocol analysis were used. A grounded theory approach was used to analyze the concepts, categories and themes that emerged in the qualitative data. Results: Twenty-four participants (33%) had died by the time of follow up. At three months, n=9 (12%) had been lost to follow up and 40(55%) was successfully followed up. The preoperative median VAS was 60 (n=40). The postoperative median VAS was 70. The EQ-5D items on mobility and usual activities were reported as having deteriorated significantly postoperatively (p=0.04, p=0.001respectively) while pain/discomfort had improved (p=0.003). There was no improvement in QOL median VAS from the preoperative status to three months postoperatively The preoperative median total BI score was (n=40). The postoperative median total BI score was 19. There was a reduction in function (median BI) from the preoperative status to three months postoperatively (p<0.001). The ability to transfer was improved three months postoperatively (p=0.04). Participants were also found to have a decreased ability to negotiate stairs (p<0.001). Mobility was significantly reduced three months postoperatively (p=0.04). During the postoperative stage (n=40), 38% of the participants were married. Most (53%) of the participants had no form of income. The highest percentage of participants in all instances (35%) had secondary education (grade10-11), while 25% had less than grade 5. Only one participant was homeless, 18% lived in shacks, 55% lived in homes that were not shared with other families. People with LLA in the Johannesburg metropolitan area who had no problem with mobility preoperatively (EQ-5D mobility item), who were independent with mobility (BI mobility item) preoperatively, who were independent with transfer preoperatively (BI transfer item) had a higher postoperative quality of life (postoperative median EQ-5D- VAS) compared to people who were dependent or had problems with these functions preoperatively. Being females was a predictor of higher reported quality of life compared to being male. Emerging themes from the qualitative data were psychological, social and religious themes. Suicidal thoughts, dependence, poor acceptance, public perception about body image, phantom limb related falls and hoping to get a prosthesis were reported. Some reported poor social involvement due to mobility problems, employment concerns, while families and friends were found to be supportive. Participants had faith in God. Conclusion: Participants’ QOL and function were generally scored high both preoperatively and postoperatively but there was a significant improvement in QOL and a significant reduction in function after three months although participants were generally still functionally independent. Good mobility preoperatively is a predictor of good QOL postoperatively compared to people with a poor preoperative mobility status Generally, most participants had come to terms with the amputation and were managing well while some expressed that they were struggling with reintegration to their community of origin three months postoperatively with both functional and psychosocial challenges.

O presente estudo aborda a amputação desde o momento em que passa a fazer parte das inquietações da autora, integrando seu mundo-vida, por meio de interrogações relativas à questão da amputação, suas implicações e sentimentos experimentados pela pessoa que a vivencia. Constitui-se numa investigação de caráter qualitativo, desenvolvida à luz do referencial teórico-metodológico da fenomenologia e que busca compreender, então, a vivência de uma amputação, a partir da visão da pessoa que a experiencia. Inicialmente, a fim de compreender o fenômeno que se mostra diante de meus olhos, pedindo um aclaramento, realizei um levantamento bibliográfico, o que me possibilitou conhecer a amputação sob vários enfoques, além de permitir a apropriação de algumas idéias do pensamento filosófico de Merleau-Ponty, abordando a percepção, o corpo que percebe e é percebido, na sua relação com o mundo, e o enraizamento do espírito neste corpo. Após conhecer a amputação, sob o ponto de vista literário, busquei o seu compartilhar com a pessoa a ela submetida, habitando seu mundo. Compartilhando desse momento, pude compreender seu sentido e seus significados, expressando-os sob a forma de categorias temáticas. Desta forma, foi possível desvelar algumas facetas do fenômeno amputação, além de compreender a pessoa amputada e a amputação tal como ela se mostra em si mesma. / This study addresses amputation as from the moment when it became part of the author’s concerns, integrating her world and her life, through inquiries concerning the issue of amputation, its implications and the feelings of those who experience it. It is a qualitative investigation, conducted in the light of the theoretical and methodological framework of phenomenology. Thus, its aim is to understand the experience of amputation from the viewpoint of the amputee. Initially, in order to understand the phenomenon that stands before my eyes and calls for clarification, I conducted bibliographic research, which enabled me to understand amputation better and from several points of view, as well as allowing me to appropriate some of the ideas contained in Merleau-Ponty’s philosophic thoughts, in which perception, the perceiving and perceived body, is addressed in regard to its relation with the world and the deep-rooted position of the spirit in this body. After becoming acquainted with amputation from the literary point of view, I sought to share it with an amputee, inhabiting this person’s world. By sharing this moment, I was able to understand its significance and meanings, expressing them in the form of thematic categories. Thus, it was possible to reveal some of the facets of the amputation phenomenon, besides understanding the amputee and amputation such as it reveals itself.

by Ho Kim Kong Enoch. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1991. / Includes bibliographical references (leaves 98-102). / ABSTRACT --- p.I / ACKNOWLEDGMENT --- p.IV / TABLE OF CONTENTS --- p.V / LIST OF TABLES --- p.VIII / LIST OF ILLUSTRATIONS --- p.X / Chapter CHAPTER 1 - --- INTRODUCTION --- p.1-5 / Chapter 1.1 --- Introduction / Chapter 1.2 --- Questions address / Chapter 1.3 --- Definition / Chapter CHAPTER 2 - --- LITERATURAL REVIEW - DEVELOPMENT OF HAND FUNCTION TESTS --- p.6-14 / Chapter 2.1 --- Introduction / Chapter 2.2 --- Trends of studies of hand injury in Hong Kong / Chapter 2.3 --- Previous studies to compare and relate physical and functional impairment / Chapter 2.4 --- Conclusion / Chapter CHAPTER 3 - --- FUNCTION ASSESSMENT - CRITERIA FOR THE EVALUATION --- p.15-28 / Chapter 3.1 --- Introduction / Chapter 3.2 --- Functional Anatomy / Chapter 3.3 --- Grip force study / Chapter 3.4 --- Sensation / Chapter 3.5 --- Functional assessment / Chapter 3.6 --- Conclusion / Chapter CHAPTER 4 - --- METHODOLOGY --- p.29-43 / Chapter 4.1 --- Subject selection / Chapter 4.2 --- Organization / Chapter 4.3 --- Physical assessment / Chapter 4.4 --- Functional assessment / Chapter 4.5 --- Evaluation of loss of earning capacity / Chapter 4.6 --- Control group / Chapter 4.7 --- Statistical analysis / Chapter CHAPTER 5 - --- RESULT --- p.44-57 / Chapter 5.1 --- Introduction / Chapter 5.2 --- Subject characteristics / Chapter 5.3 --- Result of individual tests / Chapter 5.4 --- Assessment of loss of earning capacity / Chapter 5.5 --- Hand function assessment after return to work / Chapter 5.6 --- Effect of severity of injury / Chapter CHAPTER 6 - --- DISCUSSION --- p.58-67 / Chapter 6.1 --- Introduction / Chapter 6.2 --- Impairment of hand function in finger amputation / Chapter 6.3 --- The effect of return to work / Chapter 6.4 --- Official schema for assessment of percentage of loss of earning capacity / Chapter 6.5 --- Severity of injury and the outcome / Chapter 6.6 --- The hand assessment protocol / Chapter CHAPTER 7 - --- CONCLUSION --- p.68-70 / APPENDIX --- p.71-90 / ILLUSTRATIONS --- p.91-97 / REFERENCES --- p.98-102

Thesis (B.S.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1978. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / B.S.

<p>Amputation affects men and women of all ages, classes, races and religions. The patients’ reactions are, however, entirely unique. This is a literature study comprising fourteen scientific articles which make up the results. The psychosocial effects of amputation can be daunting and considering the mountain of literature on the subject, it is therefore necessary to start by explaining some of the research on stress, crisis, and coping. Brief descriptions of Lazarus’s and Cullberg’s work have been selected to represent a sample of existing theories which have grappled with these psychosocial concepts. The purpose of this study is to describe the various coping strategies utilized by patients who have undergone amputation. The results consist of seventeen coping strategies which are divided up into five theme groups (positive coping, avoidance coping, social support, maladaptive coping, and religion). Evidence is provided which describes how the various coping strategies can actually manifest themselves in reality as witnessed by amputee patients. In conclusion, amputees use various coping strategies at different stages of recovery to deal with the trauma of their loss; these strategies can be observed and identified in both clinical and out-patient settings.</p>

Varje år insjuknar många människor världen över i sjukdomen diabetes mellitus och antalet insjuknande per år väntas öka. Sjukdomen är i de flesta fall kronisk och för med sig flertalet komplikationer. En av dessa komplikationer är amputation av nedre extremiteter på grund av sämre blodförsörjning. Syftet med denna studie var att beskriva hur diabetespatienter upplever sin livskvalitet efter en amputation. Studien är en litteraturstudie som genomfördes enligt Polit, Beck och Hungler (2005). Resultatet redovisas i tre huvudkategorier; fysisk livskvalitet, psykisk livskvalitet och social livskvalitet. Studien visar att livskvaliteten för de diabetespatienter som amputerats är lägre än för de diabetespatienter som känner sig friska men bättre än för de diabetespatienter med pågående fotsår. Livskvaliteten efter amputation påverkas av en rad olika faktorer till exempel; rörlighet, smärta, psykisk status, protesanvändande och patientens sociala nätverk.

Amputation affects men and women of all ages, classes, races and religions. The patients’ reactions are, however, entirely unique. This is a literature study comprising fourteen scientific articles which make up the results. The psychosocial effects of amputation can be daunting and considering the mountain of literature on the subject, it is therefore necessary to start by explaining some of the research on stress, crisis, and coping. Brief descriptions of Lazarus’s and Cullberg’s work have been selected to represent a sample of existing theories which have grappled with these psychosocial concepts. The purpose of this study is to describe the various coping strategies utilized by patients who have undergone amputation. The results consist of seventeen coping strategies which are divided up into five theme groups (positive coping, avoidance coping, social support, maladaptive coping, and religion). Evidence is provided which describes how the various coping strategies can actually manifest themselves in reality as witnessed by amputee patients. In conclusion, amputees use various coping strategies at different stages of recovery to deal with the trauma of their loss; these strategies can be observed and identified in both clinical and out-patient settings.

Thèse de doctorat : Ingénierie cellulaire et tissulaire : Nancy 1 : 2008. / Titre provenant de l'écran-titre.

As of 2005, there were over 1.5 million amputees living in the United States, more than 548,000 of them with upper extremity involvement. The total number of amputees is projected to rise to at least 2.2 million by 2020. Unfortunately, full functional use of upper extremity prosthetic devices is low. Knowledge gained regarding the cortical systems active in amputees performing motor tasks may reveal atypical motor control strategies that contribute to these issues. Substantial evidence demonstrates a strong dependence on left parietofrontal cortical areas to successfully plan and execute tool-use movements and pantomimes. It was previously unclear how this network functioned in users of prostheses. The hypothesis of this dissertation is that in order to optimally engage the typical parietofrontal network during action imitation with a prosthetic device, the action being imitated should be performed by a matching prosthesis. Also, that greater engagement of the parietofrontal network will result in increased ability to perform tool-use movements. First, this dissertation showed that when imitating motor tasks performed by intact actors, prosthesis users exhibit lower engagement of the parietofrontal action encoding system. This network is crucial for motor adaptation. Left parietofrontal engagement was only observed when prosthesis users imitated matched limb prosthesis demonstrations, which suggests that matched limb imitation may be optimal to establish motor representations. Next, intact subjects donned a fictive amputee model system (FAMS) to simulate the limb movement that transradial amputees experience. Matched limb imitation in FAMS users yielded better movement technique compared to mismatched imitation. Finally, the longitudinal effects of a matched limb training paradigm on the cortical action encoding activity and motor behavior in FAMS users were investigated. Matched limb imitation subjects showed greater engagement of the parietofrontal network and better movement technique compared to those trained with mismatched limb. This dissertation has clinical relevance as it supports the notion that matched limb imitation could play an important role in the performance of motor tasks using a prosthetic device. These findings could be used to inform the development of improved rehabilitation protocols that may lead to greater functional adaptation of prosthetic devices into the lives of amputees.

Abstrakt Utifrån en hermeneutisk ansats har en enkät följd av djupgående intervjuer utförts i syfte att ge kunskap och förståelse för det omlärande en amputerad genomgår. Studien har även riktats mot upplevelse av omlärande i samband med spegelterapi och digital terapi för att ytterligare belysa de amputerades upplevelser av dessa terapier. Då digital terapi än så länge är en ny terapiform som endast testats på en patient har uppfattningarna om denna metod varit begränsade. De djupgående intervjuerna har i urvalet begränsats till amputerade till följd av ett trauma. Det omlärande de amputerade upplevt har tolkats utifrån en helhetsfokuserad lärandeteori för att belysa vidden av lärande för den traumatiskt amputerade personen. Omlärandet har berört både samspelsprocessen och tillägnelseprocessen och lärandeteorins samtliga tre dimensioner. Dessutom har de amputerade upplevt att deras identitet har påverkats till följd av den traumatiska amputationen. De intervjuade upplever dessutom att deras traumatiska amputation har medfört psykologiska påfrestningar som liknar dem vid psykiskt utmattningssymptom. Det är därför av betydelse att mer forskning görs inom detta fenomen för att på så sätt ge amputerade det stöd de behöver för en bra återhämtning. Abstract Based on a hermeneutical approach a questionnaire followed by in-depth interviews was conducted in order to provide knowledge and understanding of the relearning an amputee undergoes. This study was also directed to experienced relearning in connection with mirror therapy and digital therapy to further illustrate the amputee&apos;s experiences of these therapies. When digital therapy so far is a new form of therapy that has only been tested on one patient, perceptions of this method have been limited. For the in-depth interviews the selection was limited to amputees as a result of a trauma. The relearning the amputees experienced was interpreted on the basis of a whole-focused learning theory to illustrate the breadth of learning for the traumatic amputee. The relearning has involved both the interaction process and the appropriation process and all three dimensions of the learning theory. In addition, the interviewed felt that their identity has been affected as a result of the traumatic amputation. The interviewed also experienced that their traumatic amputation has led to psychological stresses similar to those of mental fatigue symptoms. It is therefore important that more research is done in this phenomenon so as to give amputees the support they need for a good recovery. / therese_liden@hotmail.com