>Magister Scientiae - MSc / Persons with lower limb amputations (LLA) experience different challenges in the community. These challenges include the physical, psychological and social function of an individual. Little is known in Malawi on what persons with lower limb amputations go through in the communities where they live. Therefore, the study aimed at exploring and determining community experiences of persons with LLA in Malawi. The study sought to address the following objectives: 1) To determine the functional and psychological status of persons with LLA in the community; 2) To explore and describe experiences on social participation of persons with LLA in the community; 3). To explore experiences on community re-integration following LLA. A mixed method approach was applied where quantitative and qualitative data were collected simultaneously to provide a more holistic overview of the experiences of persons with LLA at one point in time. The study setting was Queen Elizabeth Central Hospital (QECH) and Kamuzu Central Hospitals (KCH) (500 miles), located in Malawi. A sample of 180 participants was recruited to participate in the study. Three self-administered questionnaires (socio-demographic questionnaire, OPUS module of lower extremity functional status, and a Beck’s depression inventory scale) and a semi-structured interview guide were used for data collection. Thematic data analysis was used to analyze qualitative data, while quantitative data was analyzed using descriptive and inferential statistics. Ethical clearance was obtained from the University of the Western Cape Biomedical Research Ethics Committee (BMREC) and College of Medicine Research Ethics Committee (COMREC). Permission to conduct the study was obtained from KCH (500 miles) and QECH. Privacy andconfidentiality was strictly observed such that data obtained was anonymous. It was kept in a secure place, and electronic data was secured using a password.

Reproduction de : Thèse d'exercice : Médecine : Nancy 1 : 2005. / Titre provenant de l'écran-titre.

Amputacija – tai galūnės ar kitos kūno dalies dalinis arba visiškas pašalinimas. Atlikus kojos amputaciją, sutrinka daugelis mobilumo funkcijų. Šio darbo tikslas – įvertinti Barthel indekso, Judėjimo indekso - 5 bei Judėjimo ir pasitikėjimo savimi skalės jautrumą pacientams po kojos amputacijos. Šio darbo uždaviniai: įvertinti pacientų po kojos amputacijos šlaunies srityje funkcinę būklę Barthel indeksu, Judėjimo indeksu – 5 bei pasitikėjimo savimi lygį Judėjimo ir pasitikėjimo skale prieš ir po reabilitacijos II ir III etapų; nustatyti funkcinės būklės bei judėjimo ir pasitikėjimo vertinimo skalių tarpusavio ryšį; nustatyti funkcinės būklės bei judėjimo ir pasitikėjimo vertinimo skalių jautrumą. Taikyti metodai: Tyrimas buvo atliktas VšĮ „Valakupių reabilitacijos centre“. Ištirta 19 žmonių (amžiaus vidurkis − 70 metai, diapazonas − 51 − 79 metai, 15 vyrų ir 4 moterys), atvykusių į gydymosi ��staigą po šlaunies amputacijos gydomojo protezo pritaikymui ir vėliau atvykusių pastovaus protezo pritaikymui.. Tyrime buvo vertintas Barthel indeksas, Judėjimo indeksas, Judėjimo ir pasitikėjimo savimi skalė. Buvo tiriamas skalių jautrumas bei ryšys tarp šių matavimo priemonių. Matematinė statistika atlikta naudojantis Microsoft Excel XP ir programiniu paketu STATISTICA 6.0. Rezultatai: nustatyta, kad Barthel indekso, Judėjimo indekso bei Judėjimo ir pasitikėjimo savimi skalės jautrumo efekto dydis yra didesnis nei 0,8. Judėjimo ir pasitikėjimo savimi skalė neturi jokio patikimo ryšio... [toliau žr. visą tekstą] / Amputation is the partial or entire removal of a body extremity or other part of a body. Many functions of mobility are deficient after leg amputation. Main goal of the thesis is to assess responsiveness of the Barthel index, Locomotor capability index – 5 and Activities-specific Balance Confidence Scale for patients after leg amputation. The tasks of the thesis are, first, to evaluate condition of the patients after femoral amputation applying the Barthel index, Locomotor capability index – 5 and Activities-specific Balance Confidence Scale before and after 2nd and 3rd stages of rehabilitation; second, calculate correlation between the functional condition and balance confidence assessment scales; third, evaluate responsiveness of the functional condition and balance confidence assessment scales. Research methods. The research was conducted at the Valakupiu Rehabilitation Center. The sampling of the research included 19 patients after femoral amputation (mean age 70, range 51 – 79, 15 men and 4 women) during their prosthetic rehabilitation. The Barthel index, Locomotor capability index – 5 and Activities-specific Balance Confidence Scale were assessed in the research. Responsiveness of the scales was evaluated and correlation between them has been calculated. Microsoft Excel XP and software package STATISTICA 6.0 were used for data analysis. Results of the research show that responsiveness of the Barthel index, Locomotor capability index – 5 and Activities-specific Balance... [to full text]

Determining whether stoning for adultery and hand-amputation for theft were practiced in pre-Islamic Arabia represents the first phase in exploring the origins and evolution of these penalties in Islamic law. Should both punishments prove to predate Islam, then it would appear the Qur'an broke with stoning and confirmed amputation of the hand. An extensive survey of pre-Islamic, Near Eastern legal materials in search of parallel penalties has thus been attempted in this thesis. Remarkably, not only stoning and hand-amputation, but nearly the entire range of Islamic adultery and theft legislation have pre-Islamic parallels. The nature of these parallels, however, does not conform to the paradigm of 'borrowing' from 'foreign' sources. Rather, Arab customary law---a major contributor to Islamic law in general---appears to have diverged from an ancient Semitic 'common source' once shared with other Near Eastern cultural entities. Most major elements of Islamic criminal law, including stoning and hand-amputation, therefore represent the culmination of an ancient Semitic common law.

In Lithuania there is a widespread opinion that the best time for applying prosthesis for lower extremity is, on average, six months after the amputation. However, in many countries the process of preparation for prosthetics begins immediately after leaving the surgical department. The aim of this work was to estimate the effect of health returnable on mobility of the patients after the lower extremity amputation in the primary stage of prosthetics. The patients whom the early physiotherapy program after the amputation was applied, were compared with the patients who came back to hospital for prosthetic after 8,5 months after trans-tibial amputation without the health returnable treatment. The muscle force of the amputated lower extremity and the knee and hip joint motion range were measured for both groups of the patients before and after the primary prosthetics stage. The patients balance and mobility were estimated using the “Functional reaching” and “Get up and go” tests. The patients who came for prosthetics, on the average, after 8,6 months had lower range of knee and hip joint extension, a weaker force of calf and thigh extension, abduction. The worse results were obtained in performing the “Get up and go” test, which requires the ADL: to stand up, to turn, to go, and to sit down on the chair. The muscle force, the range of motion, balance and motor abilities reliably improved in both groups after the primary prosthetics. However, the patients who underwent the health... [to full text]

Hand dominance is the preferential use of one hand over the other for motor tasks. 90% of people are right-hand dominant, and the majority of injuries (acute and cumulative trauma) occur to the dominant limb, creating a double-impact injury whereby a person is left in a functional state of single-handedness and must rely on the less-dexterous, non-dominant hand. When loss of dominant hand function is permanent, a forced shift of dominance is termed injury-induced hand dominance transfer (I-IHDT). Military service members injured in combat operation may face I-IHDT following mutilating injuries (crush, avulsion, burn and blast wounds) that result in dominant limb amputation or limb salvage. Military occupational therapy practitioners utilize an intervention called Handwriting For Heroes to facilitate hand dominance transfer. This intervention trains the injured military member how to write again using the previously non-dominant hand. Efficacy and clinical effectiveness studies were needed to validate the use of this intervention. This dissertation contains three studies related to I-IHDT. One study measured handwriting performance in adults who previously (greater than 2 years ago) lost function of their dominant hands. Results verified that handwriting performance, when measured on two separate occasions (six-weeks apart) was similar (stable). A second study examined the efficacy of Handwriting For Heroes in non-impaired participants. Results demonstrated a positive effect on the variables that measured the written product: legibility, writing speed (letters-per-minute); as well as a positive effect on the variables that measured the writing process: kinematic and kinetic parameters. The final study examined the clinical effectiveness of Handwriting For Heroes in an injured military population. Results did not show as positive results as the efficacy study, despite similar compliance with the intervention. Specifically, non-impaired participants started with faster writing speeds in their non-dominant hands (higher letters-per-minute) and made more gains (wider ranges). The non-impaired participants also started with faster dexterity (betters scores on the Grooved Pegboard) but they made fewer gains than the injured service members (smaller ranges). Nevertheless, injured participants clearly made gains in all dependent variables thereby demonstrating clinical effectiveness of the intervention

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Bakgrund: För att minska risken för fallrelaterade skador hos amputerade är envaliderad modell som beskriver och undersöker balans viktigt. The invertedpendulum model (IPM) är en validerad modell som beskriver människans posturalakontroll vid stående. Validiteten är ifrågasättbar för transtibialtamputerade då desaknar aktiv plantarflektion i ankelleden. Därför hypotiserade Rusaw och Ramstrand(2016) att en ny modell krävdes.Metod: Protesanvändare (n = 8) och en kontrollgrupp (n = 7) utförde tre tester,stående på två kraftplattor, under tre olika villkor (totalt 9 tester). Villkoren var ögonöppna, ögon stängda samt feedback på viktfördelning. Data samlades in ochkorrelationskoefficienterna beräknades för att undersöka skillnaderna mellangruppernas medelvärden. För att validera modellen kinetiskt använde Alinder ochEdholm mekaniska begränsningar på kontrollgruppen. Detta i form av en anordningsom låste centre of pressure till en specifik punkt.Resultat: Som hypotiserat blev korrelationen mellan vänster sida för kontrollgruppen(r = -0.557) och den intakta sidan för protesbrukarna (r = -0.423) negativ. Dessutomvar korrelationen och för både protesanvändarna (r = 0.024) och kontrollgruppen (r= 0,207) nära 0 på högersida.Slutsats: Rusaw och Ramstrands (2016) nya modell kunde valideras utifrån resultatetpå denna studie.

Orientador: Bruno Livani / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T22:20:14Z (GMT). No. of bitstreams: 1 Mongon_MauricioLealDias_D.pdf: 3191083 bytes, checksum: 7d82ec3811a7941ce0efb53f33c4ecea (MD5) Previous issue date: 2014 / Resumo: Introdução: A amputação, especialmente dos membros inferiores, é um procedimento cirúrgico antigo que permite excelentes resultados quando realizada nas indicações apropriadas. Na década de 1940 , Ertl desenvolveu uma técnica reprodutível para amputação transtibial com o princípio de osteomioplastia , que restaurou a pressão intra-óssea por meio da obliteração do canal medular e ampliou a área de apoio terminal , formando uma ponte óssea entre a fíbula e a tíbia distais (sinostose). Objetivos: O objetivo deste estudo foi investigar a eficácia de uma modificação da técnica original Ertl, em que um retalho pediculado osteoperiosteal é usado para formar a ponte óssea na amputação transtibial em adultos . Resultados: Todos os nove pacientes apresentaram cotos indolores e capazes de apoio terminal total em 24 semanas pós-operatório. Conclusão: A construção de um retalho pediculado tibial osteoperiosteal cortical para alcançar uma ponte óssea durante a amputação transtibial é um procedimento seguro e eficaz que proporciona um coto estavel e indolor que permite apoio terminal. Trata-se de uma opção útil para pacientes jovens , atletas e pacientes com grande demanda física / Abstract: Background: Amputation, especially of the lower limbs, is an ancient surgical procedure that gives excellent results when conducted under the appropriate conditions. In the 1940s, Ertl developed a reproducible technique for transtibial osteomyoplastic amputation, which restored the intraosseous pressure through canal obliteration and expanded the area of terminal support by forming a bony bridge between the fibula and distal tibia. Objectives: The aim of this study was to investigate the effectiveness of a modification of the original Ertl technique, whereby a cortical tibial osteoperiosteal flap technique is used to achieve a bony bridge during transtibial amputation in adults. Results: All of the patients had stumps that were painless and able to bear the total terminal weight at 24th week post-surgery. Conclusion: The construction of a cortical tibial osteoperiosteal flap to achieve a bony bridge during transtibial amputation is a safe and effective procedure that provides a strong and painless stump that is terminal weight-bearing. This constitutes a useful option for young patients, athletes, and patients with high physical demands / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Orientador: Bruno Livani / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T12:14:39Z (GMT). No. of bitstreams: 1 Carvalho_JoseAndre_D.pdf: 5523749 bytes, checksum: 5c534ff80bb87a60f0d6051a9ccc279b (MD5) Previous issue date: 2012 / Resumo: A escolha do nível de amputação e da técnica cirúrgica a ser adotada nas amputações dos membros inferiores deve ser avaliada com muita atenção, pois influenciará diretamente na reabilitação física e na protetização do amputado. A preservação da articulação do joelho permitirá ao amputado uma marcha mais fisiológica e o processo de reabilitação mais funcional. Em situações específicas como nos traumas ortopédicos com lesão grave do membro inferior, a opção por uma amputação transtibial realizada imediatamente abaixo da tuberosidade tibial com manutenção da inserção do tendão patelar, pode resultar em cotos extremamente curtos, porem cotos funcionais. Amputados com cotos transtibiais extremamente curtos, com comprimento ósseo médio de 4,4cm, ao final do tratamento encontravam-se plenamente adaptados as próteses e satisfeitos com a qualidade de marcha após a reabilitação. Em situações eletivas, a indicação de amputações transtibiais clássicas podem ser substituídas por amputações com periosteoplastia tibio-fibular ou amputações com o uso do retalho plantar neuro-vascular pediculado e com fusão do calcâneo à tíbia. Os pacientes submetidos à técnica de periosteoplastia apresentaram grande capacidade na realização de descarga distal sem dor, durante a utilização de suas próteses. Pacientes submetidos às amputações transtibiais com uso do retalho plantar neuro-vascular pediculado e com fusão do calcâneo à tíbia, apresentaram como resultado um coto ósseo distal bastante estável, com maior área terminal para descarga de peso e fixação do próprio soquete protético, contribuindo muito no processo de reabilitação. Nestas três situações distintas, realizadas com técnicas cirúrgicas não convencionais, como nos cotos transtibiais extremamente curtos, na perioplastia tibio-fibular e com uso retalho plantar neuro-vascular pediculado e fusão do calcâneo à tíbia; excelentes resultados puderam ser observados no processo de reabilitação e na confecção customizada das próteses, quando comparada com as amputações transtibiais clássicas / Abstract: The choice of the level of amputation and surgical technique to be adopted in lower limb amputations should be assessed carefully, because it will influence directly on the fitting and physical rehabilitation of the amputee. The preservation of the knee joint renders the amputee a more physiological gait and a more functional process of rehabilitation. In specific situations, such as orthopedic trauma with severe lower limb injury, the option for a transtibial amputation performed just below the tibial tuberosity, with maintenance of the insertion of the patellar tendon, can result in extremely short, stumps, but functional stumps. Transtibial amputees with stumps extremely short, with an average bone length of 4.4cm, were fully adapted to the prostheses and satisfied with the quality of gait after rehabilitation. In elective situations, the classical transtibial amputations can be substituted by amputations with tibio-fibular periosteoplasty or the use of a neuro-vascular pediculated plantar flap graft, with fusion of the calcaneous to the tibia. Patients undergoing periosteoplasty technique presented a painless and high capacity terminal discharge during use of the prostheses. Patients submitted to a neuro-vascular pediculated plantar flap graft with fusion of the calcaneous to the tibia, presented a stable distal bone stump with a larger distal bearing area and better fixation of the prostheses, contributing positively to the rehabilitation process. In these three different situations, that made use of no convencional surgical techniques, as in the extremely short leg stumps, tibio-fibular periosteoplasty and the use of a neuro-vascular pediculated plantar flap graft, with fusion of the calcaneous to the tibia; excellent results may be achieved in the rehabilitation process and in the fitting of custom prostheses, when compared with traditional transtibial amputations / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências