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.

Masters of Science - Msc (Physiotherapy) / Vocational rehabilitation relates to rehabilitating a person with an amputation back into actively participating in society. Although vocational rehabilitation is important, before it can be implemented, the participation restrictions should be identified. Even though lower limb amputation surgery is commonly performed in South Africa, and given the high unemployment rate in the country, no research has been done into the participation restrictions and vocational needs of a person with a unilateral lower limb amputation in the Western Cape. The aim of this study was to determine and explore the participation restrictions and vocational rehabilitation needs in terms of hobbies, sport activities, employment and employment needs of persons with a unilateral lower limb amputation (LLA) in the Western Cape. The objectives were to: 1) Determine the participation restrictions of persons with a unilateral LLA in the Western Cape. 2) To explore the vocational rehabilitation needs of persons with a lower limb amputation. A mixed methods approach, and an explanatory sequential design was used in this study. The study was conducted in two phases. The first phase utilised a quantitative approach and the WHODAS 2.0 was used as the instrument to collect data. The second phase aimed to explain the data collected in the first phase in more depth, and semi-structured telephonic interviews were utilized to collect the qualitative data. The study was set in the Cape Metropole region of the Western Cape. Participants were recruited from Tygerberg Tertiary Hospital and a private sub-acute rehabilitation centre. In the quantitative (first) phase of the study, 50 participants were conveniently recruited to participate. In the second phase eight participants were purposefully selected from the pool of 50 participants from the first phase of the study who consented to participate in the second phase. Quantitative data was analysed using SPSS vs. 22 and analysed for descriptive and inferential statistics. Qualitative data has been analysed using Creswell's seven step process of thematic analysis. Ethical clearance has been obtained from the University of the Western Cape, permission to access patients' details has been obtained from Tygerberg Tertiary Hospital and private sub-acute rehabilitation centre. Written informed consent as well as permission for audio recording during the telephonic interview was obtained.

ITC/USA 2009 Conference Proceedings / The Forty-Fifth Annual International Telemetering Conference and Technical Exhibition / October 26-29, 2009 / Riviera Hotel & Convention Center, Las Vegas, Nevada / Even after rehabilitation, patients with lower-limb amputation may continue to exhibit suboptimal gait. A wireless telemetry system, featuring force sensors, accelerometers, control electronics and a Bluetooth transmission module was developed to measure plantar pressure information and remotely monitor patient mobility. Plantar pressure characterization studies were performed to determine the optimal sensor placement. Finally, the wireless telemetry system was integrated with a previously developed haptic feedback system in order to allow remote monitoring of patient mobility during haptic system validation trials.

>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.

Thesis (MScMedSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Lower limb amputations cause multiple physical, psychological, environmental and socioeconomic barriers. Individuals who have suffered a lower limb amputation require comprehensive rehabilitation to ensure social integration and economic self-sufficiency. In addition, constant monitoring and evaluation is an essential part of human service delivery programmes. However, the amputation rehabilitation programme offered at Elangeni an outpatient rehabilitation centre for clients with physical disabilities in Paarl, Western Cape, South Africa is not monitored, and has not been evaluated since its inception in 2000. Thus, the current study evolved to describe and evaluate the rehabilitation programme for persons with lower limb amputations at Elangeni. A mixed method descriptive design was implemented. All persons who received rehabilitation, after a major lower limb amputation at Elangeni, between 2000 to 2011, were included in the study population. In addition, the physiotherapist and occupational therapist that provided amputation rehabilitation at Elangeni, at the time of the study, were interviewed. Thirty participants who met the study inclusion criteria were identified. Quantitative data was collected using a researcher designed, structured demographic questionnaire, an International Classification of Function checklist based questionnaire and a participant rehabilitation folder audit form. Two interview schedules one for clients and one for therapists were used for guidance during semi structured interviews. Quantitative data was entered onto a spread sheet and analysed by a statistician using Statistica, version 8. Qualitative data was thematically analysed according to predetermined themes. No programme vision, mission or objectives could be identified for the amputation rehabilitation programme. Poor record keeping practices and a lack of statistics were found. Rehabilitation was impairment focused with no attention given to social integration. Clients who received prosthetic rehabilitation showed improved functional ability with regard to picking up objects from the floor (p = 0.031) getting up from the floor (p = 0.00069), getting out of the house (p = 0.023), going up and down stairs with a handrail (p = 0.037) and moving around in the yard (p = 0.0069), climbing stairs without a handrail (p = 0.037), going up and down a kerb (p = 0.0082) walking or propelling a wheelchair more than 1km (0.0089) and walking in inclement weather (0.017). A lack of indoor mobility training had a statistically significant negative impact on the participants’ ability to lift and carry objects (p 0.011), standing up from sitting (p = 0.042), getting around inside the house (p = 0.00023), picking up objects from the floor (p = 0.00068), getting up from the floor (p = 0.0072), getting out of the house (p = 0.0016), going up and down stairs with a handrail (p = 0.019), moving around in the yard (0.0013), going up and down stairs with-out a hand-rail (p = 0.019), getting up and down a kerb (p = 0.0022), walking or wheeling 1km or more (p = 0.0032) and using transport (p = 0.0034). Failure to address community mobility during rehabilitation had a statistically significant negative impact on all aspects of community mobility scores except doing transfers and driving. In conclusion, for the study participants, Elangeni failed to provide rehabilitation according to the social model of disability and Community Based Rehabilitation principles. It is recommended that managers, service providers, and clients re-consider the purpose of Elangeni and develop a vision and objectives for that service. In addition, management should take an active role in service monitoring and evaluation and provide guidance and mentorship to therapists. / AFRIKAANSE OPSOMMING: Onderste ledemate amputasies impak negatief op `n persoon se fisiese, sielkundige en sosiale funksionering. Individue wat ’n amputasie ondergaan het benodig omvattende rehabilitasie om sosiale integrasie en ekonomiese onafhanklikheid te verseker. Konstante monitering en evaluasie is ’n essensiële deel van rehabilitasie programme. Nietemin die amputasie rehabilitasie program wat by Elangeni aangebied word, word nie gemoniteer nie en was nog nooit geëvalueer nie. Dus het hierdie studie dit ten doel om die rehabilitasie programme vir persone met onderste ledemate amputasies by Elangeni te beskryf en te evalueer. Kwantitatiewe en kwalitatiewe navorsingsmetodes is in kombinasie gebruik in die studie. Alle persone wat rehabilitasie by Elangeni ontvang het na ’n onderste ledemaat amputasie, sowel as die terapeute wat by Elangeni werk, het die studie populasie gevorm. In totaal het 32 persone aan die studie deelgeneem. Kwantitatiewe data is met behulp van `ʼn demografiese vraelys, `ʼn ICF gebaseerde vraelys, en `ʼn leer oudit vorm ingesamel. Twee onderhoud skedules, een vir die kliënte en een vir die terapeute, is gebruik as riglyn tydens insameling van kwalitatiewe data. Kwantitatiewe data is statisties ontleed deur ʼn statistikus wat gebruik gemaak het van Statistica 8. Voorafbepaalde temas is gebruik tydens tematies ontleding van kwalitatiewe data. Geen program visie, missie of doelwitte kon geïdentifiseer word nie. Swak rekord houdings praktyke was gevind. Rehabilitasie het gefokus op die fisiese en nie op sosiale integrasie nie. Die kliënte wat prostetiese rehabilitasie ontvang het, het statisties beduidend beter gevaar ten opsigte van optel van voorwerpe van die vloer af (p = 0.031), om van die vloer af op te staan (p = 0.00069), om uit die huis uit te kom (p = 0.023), om trappe met `ʼn handreling te klim (p = 0.037), om op die erf rond te beweeg (p = 0.0069), om trappe sonder `ʼn reling te klim (p = 0.037), om by sypaadjies op en af te gaan (p = 0.0082), om meer as `ʼn kilometer te loop of met die rolstoele te ry (0.0089) en om in ongure weer te loop (0.017). `ʼn Tekort aan heropleiding van mobiliteit binne die huis het `ʼn statisties beduidende impak gehad op die vermoë om goed te dra (p 0.011), op te staan van sit af (p = 0.042), in die huis rond te beweeg (p = 0.00023), voorwerpe van die vloer af op te tel (p = 0.00068), van die vloer af op te staan (p = 0.0072), uit die huis uit te kom (p = 0.0016), trappe met `ʼn handreling te klim (p = 0.019), in die erf rond te beweeg (0.0013), trappe sonder `ʼn handreling te klim (p = 0.019), by `n sypaadjie op en af te gaan (p = 0.0022), meer as 1km te loop of met die rystoel te ry (p = 0.0032) en om vervoer te gebruik (p = 0.0034). `ʼn Gebrek aan heropleiding van gemeenskapsmobiliteit het `ʼn statisties negatiewe impak gehad op alle aspekte van gemeenskapsintegrasie behalwe die doen van oorplasings en bestuur. Rehabilitasie praktyke was nie gebaseer op die sosiale model van gestremdheid en Gemeenskap Gebaseerde Rehabilitasie beginsels nie. Dit word aanbeveel dat diens verskaffers, kliënte en bestuurders oor die fokus van rehabilitasie by Elangeni moet besin. Daar moet ʼn visie en doelwitte vir die diens ontwikkel word. Voorts moet bestuurders van distrik vlak ʼn aktiewe rol speel in die monitering en evaluasie van dienste en mentorskap aan terapeute verseker.

L'imagerie motrice, ou représentation interne d'un mouvement, est une technique d'entraînement mental ayant la particularité d'impacter la plasticité cérébrale activité-dépendante. La pertinence de son intégration au sein des programmes de rééducation fonctionnelle a été validée par de nombreuses études expérimentales, tout particulièrement pour les personnes victimes d'un accident vasculaire cérébral ou d'une lésion de la moelle épinière. Les résultats obtenus par ce travail de thèse élargissent l'éventail des populations pouvant bénéficier de cette approche en validant la faisabilité et en précisant les conditions optimales de l'intégration de l'imagerie motrice dans le cadre de la rééducation de personnes amputées du membre inférieur. Nous rapportons également des résultats préliminaires prometteurs quant à ses effets sur le recouvrement de leurs capacités locomotrices. Les données montrent que le travail en imagerie motrice devrait être spécifique aux mouvements fonctionnels bilatéraux et que, sous réserve d'une prochaine validation auprès de cette population, l'imagerie motrice de tâches posturales ainsi que l'utilisation conjointe de la stimulation transcrânienne à courant continu, devraient permettre de maximiser son pouvoir d'action sur le recouvrement de la locomotion de personnes amputées du membre inférieur / Motor imagery, which refers to the internal representation of a movement, has the potential to impact activity-dependent plasticity. The relevance of motor imagery, as a technique allowing substantial motor performance gains and motor recovery in the field of rehabilitation, has been validated by numerous experimental studies in stroke patients and persons suffering from spinal cord injury. By highlighting the possibility of integrating motor imagery within the framework of lower-limb amputees’ rehabilitation programs, and revealing promising preliminary data regarding locomotion recovery, the results of this thesis broaden the range of people which might benefit from this technique. Data further suggest that motor imagery should specifically focus on functional and bilateral tasks, and that concomitant use of transcranial direct current stimulation should contribute to potentiate the impact of motor imagery on locomotion recovery of lower-limb amputees

Ce travail porte sur deux thèmes principaux. Le premier est relatif à la drépanocytose et comprend deux études. La première a examiné les connaissances qu’ont 178 hommes et femmes vivant au Bénin sur la maladie, ses causes, ses effets et sa prise en charge. Ils ont répondu à un questionnaire et, leurs réponses ont été comparées à celles d’un groupe d’expert. Il en est ressorti qu’il existait une méconnaissance globale de la maladie, et plus particulièrement de ses symptômes les plus graves et de son traitement. Les résultats révèlent que plus on a un niveau d’éducation élevé, moins on se fait de fausses idées concernant la maladie. En outre, cette méconnaissance était plus accrue chez les personnes se déclarant porteuses du trait génétique (4.83) ou drépanocytaire (5.19) que chez les personnes ayant déclaré ne pas être porteuses (3.72) ou saines (3.62). La deuxième étude a quant à elle cherché à savoir si les 137 personnes interrogées vivant au Bénin, avaient intégré de façon adéquate les règles de transmission génétique de la maladie, en se basant sur la théorie fonctionnelle de la cognition. L’analyse des données a permis de distinguer trois clusters distincts. Dans le premier groupe (n=46), les personnes jugeaient ainsi le risque de transmission de la maladie plus élevé en présence de l’un ou l’autre des deux parents atteints. Dans le deuxième groupe (n=51), le risque était jugé d’autant plus grand que chacun des parents était lui-même gravement atteint. Dans le troisième groupe (n=40), le risque n’avait été jugé élevé qu’en présence des deux parents atteints. Le deuxième thème a donné lieu à une étude, visant à examiner les motifs pouvant sous-tendre un refus d’amputation chez 224 personnes vivant au Bénin, par l’approche de la théorie du renversement. Les résultats montrent que la peur de la perte de l’identité personnelle, la peur des hôpitaux et du personnel médical, la conviction que la chirurgie était inutile, le manque de confiance dans la compétence et le dévouement des médecins, la peur de la perte de l’estime de l’autre et celle de la perte de la force spirituelle, font partie des facteurs principaux pouvant motiver un refus d’amputation. / This thesis focuses on two main themes. The first one is related to sickle cell disease and the second theme is related to limb amputations. For studying the first theme, this research proposes to examine the knowledge of 178 men and women living in Benin, on the disease, its causes, effects and care. They answered a questionnaire and their responses had been compared to those given by an expert group. It had been found that there was an overall lack of awareness on the disease, and especially its most severe symptoms and treatment. The results reveal that the higher level of education they have, the less misconceptions about the disease they have. In addition, this ignorance was increased by people declaring themselves carrying the genetic trait (4.83) or sickle cell (5.19) than those who reported not being carriers (3.72) or healthy (3.62). The second study about the first theme, investigated whether the 137 respondents living in Benin had integrated adequately the rules of inheritance of the disease, based on the functional theory of cognition. Three distinct clusters emerge with data analysis. In the first group (n=46), respondents considered a higher risk of transmission if the one or the other of two parents was/were affected by the disease. In the second group (n=51), the risk was considered even greater as both parents were seriously ill. In the third group (n=40), the risk was considered as high only if both parents were touched. The second theme, Accidents involving physical injury, has motivated a study which aim was to examine the reasons that may underlie a refusal of amputation for 224 people living in Benin, by the approach of the reversal theory. The results show that the fear of losing personal identity, the fear of hospitals and medical staff, the belief that the surgery was unnecessary, a lack of confidence in the competences and dedication of doctors, the fear of losing others esteem and the loss of spiritual strength, are among the main factors motivating a refusal of amputation.

Les personnes amputées de membre inférieur (PAMI) sont très diversifiées. Ils’agit d’une population hétérogène, tant par ses origines que par ses niveaux d’amputation, ses capacités et ses projets de vie. A ces profils variés s’ajoutent une multitude de composants prothétiques ainsi que les différentes combinaisons possibles entre ces composants. Il est également important de prendre en compte les différents environnements auxquels la PAMI est confrontée quotidiennement. La Classification Internationale du Fonctionnement (CIF 2001) a été créée par l’Organisation Mondiale de la Santé et repose sur un modèle multidimensionnel. Elle est constituée de deux grandes parties : le fonctionnement d’une part et les facteurs contextuels d’autre part. Ce modèle est capable de décrire de manière globale les modifications de fonctionnement (handicap) à partir d’un problème de santé quelconque. Ainsi, une grande quantité d’informations peut être obtenues à partir du modèle de la CIF. Néanmoins, il demeure nécessaire de développer de nouveaux outils pour mieux exploiter ce modèle afin de le rendre plus intelligible et utilisable en pratique clinique courante. Pour cela, nous nous proposons d’utiliser l’Extraction de Connaissances à partir des Données (ECD). L’ECD est un processus non trivial d'identification des structures inconnues, valide et potentiellement exploitable dans les bases de données, qui permet de transformer un maximum d’informations en connaissances facilement exploitables. A partir du modèle de la CIF et conjointement avec des méthodes d’ECD, l’objectif de cette thèse est de caractériser un groupe de PAMI expertes en termes de capacités locomotrices. Ce groupe et sa liste d’indicateurs pertinents reposant sur le modèle de la CIF ont été déterminés. Ils servent de référence pour la comparaison d’autres PAMI et peuvent guider la prise en charge de cette population particulière. / The subjects with a lower-limb amputation (LLA) compose a heterogeneouspopulation, by their amputation origins, by their amputation levels, by their abilities and by their life projects. To these various LLA’s profiles we could add a multitude of prosthetic components and the combination of these components. It is also important to take into account the different environments, which the LAA are confronted daily. The International Classification of Functioning, Disability and Health (ICF 2001) was created by the Word Heath Organization and is based on a multidimensional model. The ICF is constituted by two domains: the functioning on one hand and the contextual factors on the other hand. This comprehensive-global model is able to describe the functioning (disability) from any health problem. However it remains necessary to develop new tools to better use the ICF model making it more intelligible and useful in clinical practice. For this, we proposed to use the Knowledge Discovery in Database (KDD). KDD is a non-trivial process of identification of unknown, valid and potentially-exploitable structures in database. KDD permits to transform a maximum of information in easy-exploitable knowledge. From the ICF model conjoint with KDD methods, the aim of this thesis was to characterize an expert group of LLA in terms of locomotion capacity. This group and its list of relevant indicators, based on the ICF model, were determined. They can be used as a reference to compare with others LLA improving making decision of this particular population.

The purpose of this study is to examine the position and use of an upper extremity prosthetic simulator on non-amputees. To see how a 3D printed prosthetic simulator can be optimized to serve the user correctly and accurately. In addition, this study examines the improvement of the Hosmer 5X Prosthetic Hook with the addition of newly designed trusses on to the prosthetic, as well as utilizing a new manufacturing method known as 3D printing. These topics are important because there is no standardized prosthetic simulator for schools and research facilities to use. Off the shelf prosthetic simulator cost upwards of $2000, often too expensive for early stage research. By optimizing the Hosmer 5X Prosthetic Hook with 3D printing, this new opportunity could allow amputees, from a range of income classes, to have access to a wide variety of prosthetics that are strong enough to support everyday living activities. A low-cost prosthetic that is easily distributable and accessible can give people a chance to regain their independence by giving them different options of efficient prosthetic devices, without having to spend so much. The devices in this project were design and analyzed on SOLIDWORKS, 3D scanned on the Artec Space Spider, and surfaced on Geomagic Wrap. Key results include developing a low-cost, robust prosthetic simulator capable of operating a Hosmer 5X Prosthetic hook, as well as developing a lighter version of the Hosmer 5X Prosthetic Hook that is more cost efficient and easily obtainable to the population around the world.

No / Unilateral lower-limb amputees lead with their intact limb when stepping up and with their prosthesis when stepping down; the gait initiation process for the different stepping directions has not previously been investigated. Ten unilateral amputees (5 transfemoral and 5 transtibial) and 8 able-bodied controls performed single steps up and single steps down to a new level (73 and 219 mm). Duration, a-p and m-l centre of mass and centre of pressure peak displacements and centre of mass peak velocity of the anticipatory postural adjustment and step execution phase were evaluated for each stepping direction by analysing data collected using a Vicon 3D motion analysis system. There were significant differences (in the phase duration, peak a-p and m-l centre of pressure displacement and peak a-p and m-l centre of mass velocity at heel-off and at foot-contact) between both amputee sub-groups and controls (P<0.05), but not between amputee sub-groups. These group differences were mainly a result of amputees adopting a different gait initiation strategy for each stepping direction. Findings indicate the gait initiation process utilised by lower-limb amputees was dependent on the direction of stepping and more particularly by which limb the amputee led with; this suggests that the balance and postural control of gait initiation is not governed by a fixed motor program, and thus that becoming an amputee will require time and training to develop alternative neuromuscular control and coordination strategies. These findings should be considered when developing training/rehabilitation programs.