Amputation is the traumatic or surgical loss of one or more limbs. Amputation causes physical, psychological and social damages which result in a decrease in quality of life (QV). Sports have been considered important tools for rehabilitation and social integration of amputees. The aim of this research was to assess quality of life, occupational performance, muscle strength and range of motion of adults with lower limb amputation athlete and non-athlete. The sample consisted of 45 amputees, divided into two groups: Athlete (GE, n = 23) and non-Athlete (GNE, n = 22). The collection was made in the cities of Curitiba, Aracaju and Maceió on December 2013, January and March of 2014. The tools used were The Short Form Health Survey Questionnaire (SF-36), the Canadian Occupational Performance Measure (COPM), the goniometry, and the Kendall´s muscle strength test. The tests Shapiro-Wilk, chi-squared and Mann-Whiney (p < 0.05) were used for statistical analysis. The quality of life variable showed significant differences in all eight areas tested: functioning, role limitations due to mental health emotional bodily pain, general health, vitality, social functioning, and between the groups, with the GE presented the best results, indicating better quality of life that the GNE. The Athlete group showed significant higher rates in occupational performance, muscle strength (flexor and extensor muscles of the hip) and range of motion (flexion and hip abduction). Therefore, it was concluded that there was a higher quality of life, occupational performance, muscle strength and range of motion for amputees who practice any sport. / Amputação consiste na perda ou remoção total ou parcial de um ou mais membros, de forma traumática ou cirúrgica, acarretando danos físicos, psicológicos e/ou sociais, que resultam em redução da qualidade de vida (QV). O esporte tem sido apontado como relevante ferramenta para a reabilitação e reintegração social de indivíduos amputados. O objetivo desta pesquisa foi analisar a qualidade de vida, desempenho ocupacional, força muscular e amplitude de movimento de adultos com amputação dos membros inferiores praticantes e não praticantes de esportes. A amostra foi constituída por 45 amputados, divididos em dois grupos: Esportista (GE, n = 23) e Não Esportista (GNE, n = 22). A coleta foi realizada em Curitiba, Aracaju e Maceió, no período de dezembro/2013, janeiro e março de 2014. Os instrumentos utilizados foram o questionário The Short Form Health Survey (SF-36), a Medida Canadense de Desempenho Ocupacional (COPM), a goniometria e o teste de força muscular de Kendall. Para a análise estatística, foram utilizados os testes de Shapiro-Wilk, qui-quadrado, T de Student e de Mann-Whitney (p < 0.05). Para a variável qualidade de vida, houve diferença significante em todos os oito domínios da avaliação SF-36: capacidade funcional, limitação por aspectos físicos, dor, estado geral de saúde, vitalidade, aspectos sociais, emocional e saúde mental entre os grupos, tendo o GE apresentado os melhores resultados, indicando melhor qualidade de vida que o GNE. O GE apresentou índices significantemente mais elevados de desempenho ocupacional, força muscular (para os músculos flexores e extensores do quadril) e amplitude de movimento (para flexão e abdução do quadril). Concluiu-se, portanto, que houve maior qualidade de vida, desempenho ocupacional, força muscular e amplitude de movimento para amputados que praticam alguma modalidade esportiva.

O objetivo deste estudo foi avaliar o efeito do biofeedback (BIO) associado à terapia ocupacional (TO) e à estimulação elétrica funcional (FES) na espasticidade, movimento ativo e função do membro superior de pacientes hemiplégicos. Este estudo foi realizado na Divisão de Medicina de Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Cinqüenta e nove pacientes acometidos por acidente vascular cerebral participaram do estudo por um ano; 31 receberam TO+FES duas vezes por semana + BIO uma vez por semana e 28 receberam somente TO+FES duas vezes por semana. Os pacientes foram avaliados inicialmente, após 6 meses e após 1 ano através da Avaliação da Função Manual, do Teste de Destreza Manual Minnesota, do Teste de Amplitude de Movimento e da Escala de Ashworth modificada. TO+FES+BIO melhoraram significativamente a amplitude de movimento e função dos membros superiores após 6 meses e 12 meses, quando comparado com somente TO+FES. Ambos os grupos melhoraram significativamente a espasticidade, após 6 meses e 12 meses, com diferença não significante entre eles. O uso adicional do biofeedback mostrou efeito positivo em amplitude de movimento e recuperação da função do membro superior no grupo estudado e pode representar uma importante ferramenta para a reabiltação de pacientes hemiplégicos / The objective of this was to study the effect of biofeedback (BIO) associated to occupational therapy (OT) and functional electrical stimulation (FES) on spasticity, range of motion and upper extremity function of hemiplegic patients. The study took part at the Division of Rehabilitation Medicine of the Hospital das Clínicas of the University of São Paulo School of Medicine. Fifty-nine stroke patients were studied for one year; 31 received OT+FES twice a week + BIO once-a-week and 28 received only OT+FES twice-aweek. The patients were evaluated initially, after six months and after one year with the use of Manual Function Evaluation, Minnesota Manual Dexterity Test, Range of Joint Motion Test and Modified Ashworth Scale. OT+FES+BIO significantly improved range of motion and upper extremity function after 6 months and 12 months, compared to only OT+FES. Both groups showed significant improvement of spasticity, after 6 months and 12 months, with no significant difference between them. The additional use of BIO had a positive effect in range of motion and function recovery of upper extremity in the studied group and may represent an important therapeutic tool for stroke rehabilitation

O objetivo deste trabalho é apresentar o teste de esforço com o dinamômetro isocinético na avaliação objetiva da isquemia funcional da doença arterial oclusiva de membros superiores (DAOMS). Reuniu-se 23 pacientes com DAOMS unilateral, no grupo 1. Sete pacientes, sem DAOMS foram selecionados como o grupo controle (grupo 2). Os membros testados sem DAOMS do grupo 1 e do grupo 2 não apresentaram diferença estatística. A comparação de cada membro dos pacientes do grupo 1, com e sem DAOMS mostrou que os membros com DAOMS apresentaram desempenho significativamente menor que os membros sem lesão. Este teste permite a avaliação objetiva da limitação causada pela DAOMS de forma segura e objetiva / The objective of this work is to present the results of a stress test using an isokinetic dynamometer in patients with occlusive arterial disease in upper limbs (OADUL). Group 1 has 23 patients with unilateral subclavian occlusive disease. Seven patients, without OADUL, were included in a control group (group 2). No statistically difference was found in all parameters studied between limbs without OADUL in groups 1 and 2. So, each arm in group 1 (with and without OADUL) were tested. For all these parameters, the SOD limbs presented significantly lower values than the control limbs. This test gives an objective grade of limitation of the muscle function in patients with OADUL

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No description available.

Introduction. La thérapie axée sur la répétition de tâches fonctionnelles est préconisée pour la réadaptation du membre supérieur à la suite d’un accident vasculaire cérébral (AVC). Toutefois, aucun programme d’intervention n’opérationnalise l’ensemble des composantes clés du TOT en une démarche clinique valide de rééducation du membre supérieur post AVC en ergothérapie. Objectifs. 1) Établir la validité de contenu d’un programme de rééducation du membre supérieur post AVC en ergothérapie et 2) proposer un modèle logique de l’intervention qui fait consensus auprès d’experts et d’usagers. Méthodes. Un modèle logique d’un programme de rééducation du membre supérieur post AVC en ergothérapie a été développé, puis soumis à deux méthodes de recherche pour valider le contenu et obtenir un consensus d’experts et d’usagers : 1) Méthode Delphi : 14 experts ont examiné des capsules audiovisuelles illustrant le programme d’intervention et ont répondu à deux questionnaires pour valider les objectifs, la nature de l’intervention, les ressources, les activités et les extrants; 2) Technique de groupe nominal : six usagers ayant un vécu expérientiel de l’intervention ont généré les effets ciblés. L’indice de validité de contenu, deux indices d’accord interjuges et l’analyse de contenu ont été utilisés pour analyser les données. Résultats. Près de 93 % du contenu du programme de rééducation du membre supérieur post AVC en ergothérapie obtient un indice de validité satisfaisant, dont 82 % qui font consensus auprès d’experts et d’usagers dans un modèle logique révisé. Conclusion. Le modèle logique révisé propose une vision commune, quoiqu’incomplète, d’un programme de rééducation du membre supérieur post AVC en ergothérapie basé sur le TOT. Les activités et les extrants de l’évaluation devront faire l’objet de validation lors d’une phase subséquente d’implantation. Un transfert de connaissances sur les moyens pour favoriser le sentiment d’efficacité personnelle est aussi à prévoir pour réévaluer son rôle dans le programme d’intervention. / Background. Task-Oriented Training (TOT) is the recommended approach for upper extremity rehabilitation after a stroke. To date, no program have operationalized all the key components of TOT into a valid upper extremity clinical rehabilitation process post stroke in occupational therapy. Objectives. 1) To determine the content validity of an upper extremity rehabilitation program post stroke in occupational therapy and 2) to propose a logic model reaching consensus among experts and patients. Methods. A logic model of an upper extremity rehabilitation program post stroke in occupational therapy was developed and validated. Two research methods were used to validate the content and to achieve a consensus of experts and patients : 1) Delphi method : 14 experts examined audiovisual capsules of the intervention and completed two questionnaires to validate the objectives, the nature of the intervention, the resources, the activities and the outputs; 2) Nominal group technique : six patients with experience of the intervention generated the outcomes. The content validity index, two interrater agreement statistics and a content analysis were used for data analysis. Results. Almost 93 % of the content of the upper extremity rehabilitation program post stroke in occupational therapy obtained a satisfactory validity index, including 82 % reaching consensus among experts and patients in a revised logic model. Conclusion. The revised logic model now offers a common, albeit incomplete, vision of an upper extremity rehabilitation program post stroke based on the TOT in occupational therapy. Activities and outputs of the evaluation should be validated during a subsequent implementation phase. Knowledge translation on the modalities to promote self-efficacy is also to be planned to reassess its role in the intervention program.

Bakgrund Amputation innebär att individen förlorar en liten eller stor del av kroppen som inte kan ersättas. Orsaken till amputation kan vara kärlsjukdomar, diabetes samt trauma. Amputation kan medföra fysiska och psykiska förändringar i patientens liv. Omvårdnad av dessa patienter kan vara komplex, sjuksköterskan har i sin profession en betydande roll i mötet med patienten. Syfte Syftet var att beskriva patienters upplevelser och erfarenheter efter amputation av nedre extremitet. Metod En icke systematisk litteraturöversikt genomfördes utifrån Fribergs metodbeskrivning. Sjutton originalartiklar inhämtades via databaserna PubMed och Cinahl Complete. Valda artiklar, kvalitetsgranskades och analyserades genom en integrerad analysmetod. Resultat Efter sammanställning av de nitton studierna identifierades två övergripande rubriker: Fysiologiska upplevelser och erfarenheter, psykologiska upplevelse och erfarenheter. varje kategori hade två underkategorier. Eftersom vi undersöker patientens upplevelser och erfarenheter efter amputation har vi valt att inkludera flera faktorer som påverkar patientens livskvalitet såsom sexualitet, smärta, depression och kroppsbild. Dessutom har vi även valt att inkludera benprotesens samt ADLs funktion som en faktor eftersom funktionaliteten är en viktig del av livskvaliteten. Slutsats Amputation leder till stor förändring i patientens liv, kan orsaka lidande i både den fysiska och psykiska hälsan, och ger svårigheter i patientens framtida liv. Det är viktigt som sjuksköterska att förstå och ha kunskap om den påfrestning som uppkommer efter amputation för att ge den specificerade vård som behövs i samarbete med andra yrkesgrupper för att möjliggöra att patienten ska kunna återgå till ett så normalt liv som möjligt. / Background Amputation means that the individual loses a small or large part of the body which cannot be replaced. The cause of amputation can be vascular disease, diabetes and trauma. Amputation causes physical and mental changes in the patient's life. Patient care can be complex, therefore the nurse has a significant role when interacting with patients who have undergone amputation. Purpose The purpose was to describe patients experiences after amputation of the lower extremity. Method Non-systematic literature review was performed based on Friberg's method description. Seventeen original articles were obtained via the databases PubMed and Cinahl Complete. Selected articles were quality reviewed and analyzed through an integrated analysis. Results After compiling the seventeen studies, two main categories were identified: Physiological experiences and experiences, psychological experience and experiences. Each category had two subcategories. Because we examine and study the patient's experiences after amputation, we have chosen to include several factors that affect the patient's quality of life such as sexuality, pain, depression and body image. In addition, we have also chosen to include the function of bone prosthesis and ADL as a factor because functionality is an important part of the quality of life. Conclusions Amputation leads to great change in the patient's life, which can cause suffering in physical and mental health and difficulties in the patient's future life. It is important as a nurse to understand and have knowledge of the stress that arises after amputation to provide the specified care needed in collaboration with other professions to enable the patient to return to a normal life as possible.

Introduction One out of five reported motor vehicle collision injuries occur to the upper extremities. Certain parts of The Total HUman Model for Safety (THUMS) lack validation against experimental data, including the elbow. The aim of this project is to refine and validate the elbow joint of THUMS, with focus on anatomical response of the elbow during axial impact applied to the wrist. Methods Internal contacts in the elbow were modified and new contacts assigned between bones and ligaments of the elbow. The posterior part of the radial- and ulnar collateral ligaments, and joint capsule was implemented to the model. Elasticmodulus of the cortical bones of the elbow was increased as well as the shell thickness of the humeral cortical bone. The updated model was validated against an experiment where an axial load was applied to the wrist of a female cadaver. The experimental resultant force in the wrist was then compared with the wrist force obtained from the simulations. Results The correlation between the experimental and simulation resultant wrist force for the updated model resulted in a CORA score of 0.882. This gave a 6.7% higher CORA score compared with the original model. Hourglass energy was reduced from 63.52% of internal energy to 0.78%. Energy ratio and contact energies indicated that the simulation was stable. Discussion Movement of elbow bones was assessed to be more anatomically correct, by accounting for the posterior ligament and elbow capsule support. The contact peak force in the humerus was lower and occurred earlier in the simulation in the updated model compared to the original. This is believed to be due to the reduced gap between the elbow bones after increasing the shell thickness of the humeral cortical bone. The model setup resembled the experiment in a good manner. Conclusion The upper extremity of THUMS was refined for improved biofidelity, with focus on the anatomical response of the elbow joint under an axial impact. However, further model improvements are suggested as well as extended validated against other experimental impact results. / Introduktion En av fem rapporterade krockskador med motorfordon förekommer i de övre extremiteterna. Vissa strukturer hos Total HUman Model for Safety (THUMS) saknar validering gentemot experimentell data, där armbågen är ett av dem. Syftet med detta projekt är att förfina och validera armbågsleden hos THUMS, med fokus på dess anatomiska respons under axiellt islag applicerad på handleden. Metod Interna kontakter i armbågen modifierades och nya kontakter tilldelades mellan ben och ligament. De posteriora delarna av kollateral ligament hos radius och ulna implementerades i modellen, så även armbågens ledkapseln. Elasticitetsmodulen hos de kortikala benen i armbågen höjdes och skalets tjocklek idet humerala kortikala benet utökades. Den uppdaterade modellen validerades mot ett experiment där en axiell belastning hade applicerats mot en kvinnlig kadavers handled. Den resulterande kraften i handleden från experimentet jämfördes sedan med erhållen kraft i handleden från simuleringarna. Resultat Korrelationen mellan den experimentella kraften och simulerade kraften hos den uppdaterade modellen resulterade i ett CORA-poäng på 0,882. Detta är en ökning med 6,7% jämfört med den ursprungliga modellen. Hourglassenergin reducerades från 63,52% av inre energi till 0,78%. Energiförhållandet och kontaktenergier indikerade stabil simulering. Diskussion Rörelsen av armbågens ben bedömdes vara mer anatomiskt korrekt, med hänsyn till stödet från de posteriora ligamentet och armbågens ledkapsel. Den maximala islagskraften i humerus minskade och uppträdde tidigare i simuleringen hos den uppdaterade modellen jämfört med originalet. Detta tros bero på reducerat avstånd mellan armbågens ben genom ökandet av skaltjockleken hos det humeralakortikala benet. Modelluppställningen motsvarade experimentets uppställning. Konklusion De övre extremiteterna av THUMS förfinades i syfte att förbättra biofideliteten. Fokus låg på armbågens anatomiska respons under ett axielltislag. Både ytterligare förbättringar av modellen och utökad validering mot andra experimentella islag rekommenderas. / Technology

Les amputations d’un membre supérieur sont non seulement dévastatrices pour le bien-être physique, psychologique et social des patients, mais elles comportent également des répercussions financières importantes pour l’individu et le système de santé. Les allotransplantations de tissus composites vascularisés ont été proposées en tant que solution permettant de rétablir la forme et la fonction au détriment d’une immunosuppression à vie et d’un taux élevé de rejet chronique. Les prothèses myoélectriques combinent l’expertise chirurgicale avec les avancées technologiques pour réhabiliter les fonctions motrices d’un moignon amputé, mais elles demeurent limitées par un taux élevé d’abandon et des coûts importants. Dans les systèmes de santé avec des ressources limitées, les dirigeants ont la tâche complexe de partager équitablement l’allocation de ressources entre plusieurs maladies et interventions. Dans le domaine de l’économie de la santé, les analyses de type coût-bénéfice ont été développées pour répondre à ces questions. Les mesures d’utilité doivent incorporer l’impact que le traitement suscite sur l’espérance de vie et la qualité de vie. Ces utilités sont ensuite rapportées en fonction du coût, ce qui permet aux dirigeants de la santé de déterminer dans quels traitements il serait préférable d’investir les ressources. Dans cette thèse, nous proposons un modèle pour étudier les coûts-utilité des allotransplantations de la main et des prothèses myoélectriques. Pour commencer, une étude pilote a été effectuée sur les amputations du pouce traitées avec des lambeaux libres de l’orteil, ce qui nous a permis de confirmer la faisabilité des questionnaires d’utilité conçus. Par la suite, les utilités ont été mesurées dans une population d’amputés du membre supérieur, de patients réimplantés proximalement et de contrôles en santé. Les résultats démontrent que 1) les patients réimplantés rapportent la meilleure utilité avec les prothèses myoélectriques, 2) les amputés unilatéraux préfèrent significativement les prothèses myoélectriques également, et 3) aucune différence n’a été recelée entre les deux traitements chez les amputés bilatéraux. Au final, une analyse des coûts-bénéfices a été effectuée dans le contexte du système de santé canadien, démontrant que le traitement des patients amputés unilatéralement avec des prothèses myoélectriques permettrait de sauver davantage de coûts, alors que l’écart en épargnes monétaires se rétrécit pour les amputés bilatéraux traités avec une allotransplantation ou une prothèse. Avec les résultats rapportés dans cette thèse, nous pouvons proposer une mise à jour des indications de traitements pour les patients avec une amputation du membre supérieur. Basé sur l’analyse de type coût-utilité, nous concluons que les amputés unilatéraux sont de meilleurs candidats pour des prothèses myoélectriques, alors que les deux traitements sont encore adéquats pour les amputations bilatérales. / Amputations of the upper extremity are not only devastating for the patient’s physical, psychological and social well-being, but they also yield significant financial repercussions to the individual and the healthcare system. Vascularized composite allotransplantations of the upper extremity were proposed as a solution to restore form and function, albeit to the detriment of lifelong immunosuppression and high rates of chronic rejection. New-generation myoelectric prostheses combine surgical prowess with technological refinements to rehabilitate motor functions of the amputated stump, but remain plagued by high rates of abandonment and significant costs. In healthcare systems wherein resources are limited, financial regulators have the difficult task of proposing an equitable divide of resource allocations between a multitude of diseases and interventions. In the field of health economics, cost-benefit analyses were developed to assist in this decision-making process. Utility outcome measures need to encompass the impact that a treatment elicits on life expectancy and quality of life. Comparison of utilities of different interventions as a function of cost further indicates which route healthcare regulators should partake. In this thesis, we propose a model to study cost-utilities of hand allotransplantation and myoelectric prostheses. To begin, a pilot study was performed on thumb amputations treated with free toe flaps, which allowed to confirm the feasibility of the utility questionnaires that we developed. Afterwards, utilities and quality adjusted life years were measured in a population of upper extremity amputees, proximally replanted patients and healthy controls. Findings demonstrated that 1) replanted patients reported the highest utility outcomes for myoelectric prostheses, 2) unilateral amputees significantly preferred myoelectric prostheses as well, and 3) no significant preference between both interventions was obtained in patients with bilateral amputations. Finally, a cost-benefit analysis was performed in the context of the Canadian healthcare system, demonstrating that significant savings can be achieved with treatment of unilateral amputations with myoelectric prostheses, whereas the gap in cost savings between both treatment groups becomes less significant in bilateral amputees. With the findings reported in this thesis, we can propose an update of the indications for treatment in patients with upper extremity amputations. From the perspective of cost-utility analyses, we conclude that unilateral amputees are better candidates for myoelectric prostheses, and that both treatments can still be offered in cases of bilateral amputations.

Globally, approximately 1.2 million people die each year due to traffic accidents. Upper extremity injuries account for 18% to 25% of all car accident injuries. In order to be able to analyze these crash-related injuries, Human body models(HBMs) are used as a complement to FE simulations. An example of a HBM is the THUMS SAFER that is based on a 50 percentile American male. The aim of this study was to improve the upper extremity of the THUMS SAFER with respect to Autoliv's requirements to better predict fractures. In addition, this was validated against the Forman experiment(Forman, et al., The journal of trauma and acute care surgery, vol. 77, 2014) where human cadavers of the upper extremity were axially impacted to replicate a car collision. This was done by generating the upper extremity geometry with segmentation of medical images of a right human hand in combination with the complete STL-geometry of the forearm from the Piper project. The STL-geometry of the segmented human hand and Piper forearm was integrated and a complete STL-geometry of the upper extremity was obtained. Based on the complete STL-geometry, the FE-arm HEX 4.0 was built with modelling of bones, ligaments, soft tissue and skin with corresponding material choice in accordance with Autoliv's requirements. The model HEX 4.0 was improved considering an increased mesh density from an average of 94% to 98%. HEX 4.0 was also validated against the data from the Forman experiment for experiments 5, 6 and 15. It showed a good correlation with the acceleration curves between the simulated and experimental values for the three experiments. The reaction force in the elbow was compared for experiment 15, where the simulated value 5.7 kN divided by a factor of 1.4 from 4 kN for the experiment. Furthermore, the fi rst principal strains that occurred in HEX 4.0 were analysed by 17 ms were the highest acceleration was achieved for experiments 5 and 6. Both experiments were shown to be close to the failure threshold of bones. However, the highest value e5=9.8E-03 occurred in the radius for experiment 5, while e6=9.3E-03 in a ligament for experiment 6. In addition, the failure threshold for experiment 15 exceeded 5 ms in lunate, schapoid and triquetrum. This indication of fractures is in good agreement with the experimental results where the corresponding bones resulted in fractures in experiment 15. HEX 4.0 was an improved upper extremity of the THUMS SAFER considering an increased mesh density. It is also capable of indicating fractures and corresponding positions in the form of analyzes of occurring stresses and strains. Nevertheless, improvements and further validation of HEX 4.0 has been proposed in the future work section. / Globalt, dör varje år ungefär 1.2 miljoner personer på grund av trafi kolyckor. Skador på övre extremitet utgör 18% till 25% av alla skador inom bilolyckor. För att kunna analysera dessa krockrelaterade skador används humanmodeller(HBM) som komplement för FE-simuleringar. Ett exempel på en HBM är THUMS SAFER som är baserad på en "50 percentile" amerikans man. Målet med denna studie är att förbättra över extremiten av THUMS SAFER med avseende på Autolivs krav för att bättre kunna förutspå frakturer. Dessutom validerades detta mot Forman experiment(Forman, et al., The journal of trauma and acute care surgery, vol. 77, 2014) där övre extremitet av människokadaver blev axiellt påverkade för att replikera en bilkollsion. Detta gjordes genom att generera STL-geometrin av en övre extremitet med segmentering av medicinska bilder av en höger människohand i kombination med färdig STL-geometri av underarmen från Piper projektet. STL-geometrin av den segmenterande människohanden och Piper underarmen integrerades och en komplett STL-geometri av övre extremiteten erhölls. Baserad på den kompletta STL-geometrin byggdes FE-armen HEX 4.0 med modellering av ben, ligament, mjukvävnad samt hud med motsvarande materialval i enighet med Autolivs krav. Modellen HEX 4.0 förbättrades i form av en ökad mesh densitet från medelvärdet 94% till 98%. Den validerades även gentemot data från Forman experimentet för experiment 5, 6 och 15. Det påvisade en god korrelation på accelerations kurvorna mellan de simulerade och experimentella värdena för de tre experimenten. Reaktionskraften i armbågen jämfördes för experiment 15 där den simulerade värdet 5.7 kN skiljde sig med en faktor 1.4 från 4 kN för experimentet. Ytterligare analyserades första huvudtöjningarna som uppkom i HEX 4.0 vid 17 ms, då den högsta accelerationen uppnådes för experiment 5 och 6. Det visades att båda experimenten låg nära gränsen för benfraktur, däremot uppkom det högsta värdet e5=9.8E-03 i radius för experiment 5, samt e6=9.3E-03 i ett ligament för experiment 6. Dessutom överskred gränsen för benfrakturer för experiment 15 efter 5 ms i lunate, schapoid och triquetrum. Denna indikation av frakturer stämmer väl med resultatet av experimentet där motsvarande benen resulterades i frakturer i experiment 15. HEX 4.0 är en förbättrad övre extremitet av THUMS SAFER i form av förbättrad meshdensitet. Den är även kapabel att indikera frakturer och motsvarande position i form av analyser på förekommande spänningar och töjningar. Förbättringar och ytterligare validering av HEX 4.0 föreslås för framtida arbete.