Orientador: Ricardo Machado Leite de Barros / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Fisica / Made available in DSpace on 2018-08-08T23:00:32Z (GMT). No. of bitstreams: 1 Miana_AndreiaNogueira_M.pdf: 1861684 bytes, checksum: 665eaddcfbbcd37b0517005f4dfb680e (MD5) Previous issue date: 2007 / Resumo: O propósito deste trabalho foi comparar dois protocolos para análise cinemática de velocistas em função das velocidades, segmentos corporais e ângulos articulares durante a marcha e a corrida. Um protocolo utiliza marcadores fixados diretamente sobre a pele e outro utiliza marcadores montados sobre estruturas rígidas fixadas no segmento corporal. Seis velocistas do sexo masculino, usando ambos os protocolos, andaram a 5 Km/h e correram a 20 Km/h, em uma esteira ergométrica. Os velocistas foram representados por um modelo tridimensional constituído por quinze segmentos corporais: cabeça, tórax, pelve, pés, pernas, coxas, braços e antebraços. Foram utilizadas oito câmeras de vídeo digital (120 Hz) para aquisição das imagens e a calibração das câmeras e reconstrução das coordenadas 3D dos marcadores foram feitas no software Dvideo®. O tratamento e análise dos dados foram feitos em ambiente Matlab??7.0. Os resultados mostraram que a variabilidade do comprimento dos segmentos e das distâncias entre os marcadores e a diferença máxima entre os ângulos obtidos por cada protocolo foram maiores com o aumento da velocidade, mostrando que os erros na análise do movimento durante a corrida foram maiores que estes durante a marcha. Não houve efeito das velocidades na correlação entre os ângulos obtidos por cada protocolo. A variabilidade da distância entre os marcadores foi maior nos membros inferiores do que nos membros superiores e a variabilidade do comprimento da perna foi maior do que esta nos outros segmentos. Os resultados também mostraram que a maior correlação foi encontrada entre os ângulos de flexão/extensão (0,99) obtidos por cada protocolo e para cada articulação, seguido dos ângulos de adução/abdução (0,78) e dos ângulos de rotação interna/externa (0,65). E os menores valores encontrados na diferença angular máxima foram entre os ângulos de flexão/extensão (6,3° ± 3,4°) obtidos por cada protocolo e para cada articulação, seguido dos ângulos de adução/abdução (13,2° ± 7,9°) e dos ângulos de rotação interna/externa (17,2° ± 8,4°). Os protocolos não apresentaram diferenças na variabilidade do comprimento dos segmentos e também na análise da cinemática angular, porém os ângulos de adução/abdução e rotação externa/interna devem ser observados com mais cautela / Abstract: The purpose of this study was to compare two protocols for kinematical analysis of sprinters according to velocities, body segments and joint angles during walking and running. The first protocol uses retroreflective markers mounted on fixtures attached to the body segment and the second uses retroreflective markers directly located on the skin surface. Six male athletes were studied during treadmill running at 5 and 20 Km/h and recorded with eight 120 Hz video cameras. A three-dimensional model constituted by fifteen segments represented the sprinters: head, thorax, pelvis, the right and left feet, shanks, thighs, scapulas, arms and forearms. The calibration of the cameras, the synchronization of the registrations and the 3D reconstruction of the coordinates of the markers were done in the Dvideo ® software. All data were analyzed using Matlab® 7.0. The results show that the variability of the length of the segments and of the distances between the markers and the maximum difference maximum between the angles obtained by each protocol were higher with the increase of the velocities, showing that the errors in the analysis of the movement during the running were larger than these ones during the gait. There was no effect of the velocities in the correlation between the angles obtained by each protocol. The variability of the distances between the markers in the lower limb were higher than this one in the upper limbs and the variability of the length of the shank was higher than this one in the other segments. The results also showed a higher correlation was found between the flexion/extension angles (0,99) obtained by each protocol and for each joint, followed by the abduction/adduction angles (0,78) and the angles of internal/external rotation (0,65). The lower values found in the maximum angular difference were between the flexion/extension angles (6,3° ± 3,4°) obtained by each protocol and for each articulation, followed by the abduction/adduction angles (13,2° ± 7,9°) and the angles of internal/external rotation (17,2° ± 8,4°). No differences were found in the variability of the length of the segments and also in the analysis of the angular kinematics, however the adduction/abduction and internal/external rotation angles should be regarded with much more caution / Mestrado / Biodinamica do Movimento Humano / Mestre em Educação Física

INTRODUÇÃO: Os ferimentos descolantes nos membros inferiores frequentemente se apresentam como lesões graves. Há dificuldade na decisão sobre o tratamento mais adequado, o reposicionamento e sutura do retalho ou o emagrecimento e enxertia da pele avulsionada. Este estudo avaliou os pacientes com ferimentos descolantes nos membros inferiores, analisando o perfil epidemiológico e a evolução dos pacientes de acordo com o tratamento realizado. Após a análise dos dados e a revisão da literatura, propõe-se um protocolo para padronização do atendimento. MÉTODOS: Foram avaliados retrospectivamente 42 pacientes vitimas de ferimentos descolantes em membros inferiores atendidos no HC-FMUSP entre julho de 2003 e junho de 2007. Os pacientes foram divididos de acordo com o tratamento em 2 grupos: grupo 1 (n = 21; reposicionamento do retalho) e grupo 2 (n = 21; ressecção do retalho e enxertia imediata). Os pacientes do grupo 1 foram atendidos inicialmente em outros serviços e referenciados ao HC-FMUSP com mais de 24 horas após o trauma (16 pacientes) ou foram atendidos pela cirurgia do trauma do HC-FMUSP (5 pacientes) sem a participação da cirurgia plástica nas primeiras 24 horas. Os pacientes do grupo 1 foram tratados com limpeza, reposicionamento e sutura do retalho avulsionado à posição original. Os pacientes do grupo 2 tiveram como tratamento limpeza e desbridamento da ferida, ressecção do retalho avulsionado e emagrecimento do retalho até a espessura de pele e enxertia desta pele no atendimento inicial. RESULTADOS: Dezenove pacientes do grupo 1 (90%) apresentaram necrose e perda total do retalho reposicionado, necessitando tratamento adicional com desbridamento da necrose e enxertia de pele. Dois pacientes (10%) do grupo 1 tiveram evolução favorável, não necessitando de tratamento adicional. Os pacientes dos grupos 1 e 2 apresentaram dados estatisticamente similares em relação à enxertia de pele (G1 = 81%; G2 = 86%; p > 0,999), enxertia de pele complementar (G1 = 48%; G2 = 71%; p = 0,208), cobertura com retalho cirúrgico (G1 = 14%; G2 = 19%; p > 0,999), complicações clínicas (G1 = 33%; G2 = 24%; p = 0,734), complicações cirúrgicas (G1 = 14%; G2 = 33%; p = 0,277), taxa de amputação (G1 = 10%; G2 = 29%; p = 0,238) e taxa de óbito (G1 = 0; G2 = 14%; p = 0,232). Houve diferença estaticamente significativa no tempo de internação, com os pacientes do grupo 1 permanecendo mais tempo internados (G1 = 46,2 dias; G2 = 32,5 dias; p < 0,001). CONCLUSÕES: Houve alto índice de necrose do retalho avulsionado ! nos pacientes que receberam o tratamento de reposicionamento e sutura do retalho ao leito de origem (90%; grupo 1). O tratamento de ressecção do retalho avulsionado, emagrecimento até a espessura de pele e enxertia imediata (grupo 2) proporcionou melhor evolução com relação ao tempo de permanência hospitalar. / INTRODUCTION: Lower extremity degloving injuries are often characterized as serious injuries. There is difficulty in deciding on the most appropriate treatment, whether flap repositioning and suturing or converting the avulsed flap to split-thickness skin grafting. This study assessed patients with degloving injuries in lower extremities, reviewing the epidemiological profile and patient outcome related to the performed treatment. After data analyzing and literature reviewing, a treatment protocol is proposed for standardization of care. METHODS: Forty-two patients were retrospectively evaluated, grouped in 2 groups according with the treatment performed: group 1 (n = 21; flap repositioning) and group 2 (n = 21; flap resection and skin grafting). Group 1 was cared initially in other hospitals (16 patients) or by trauma surgery team in our hospital (5 patients) and it had treatment with washing, repositioning and suturing of avulsed flap to the original position. Group 2 had treatment with washing, debridement, resection of avulsed flap and converting the flap to split-thickness graft in the first care. RESULTS: Nineteen patients in the group 1 (90%) followed necrosis and total flap loss. These patients had additional surgery for skin grafting. Patients of groups 1 and 2 had similar finds with relation to skin grafting (G1 = 81%; G2 = 86%; p > 0,999), complementary skin grafting (G1 = 48%; G2 = 71%; p = 0,208), surgical flap (G1 = 14%; G2 = 19%; p > 0,999), clinical complications (G1 = 33%; G2 = 24%; p = 0,734), surgical complications (G1 = 14%; G2 = 33%; p = 0,277), amputation rate (G1 = 10%; G2 = 29%; p = 0,238) and death rate (G1 = 0; G2 = 14%; p = 0,232). There was statistical significant difference in length of hospital stay, with patients of group 1 staying longer inhospital (G1 = 46,2 days; G2 = 32,5 days; p < 0,001). CONCLUSIONS: There was high rate of flap necrosis in group 1 (90%) that had repositioning and suturing of avulsed flap. Group 2, with resection, defatting and immediate skin grafting, had better outcome in relation to inhospital stay.

Bakgrund: Att genomgå en amputation är en livsomvälvande händelse som bjuder på utmaningar både fysiskt och psykiskt för den drabbade personen inte minst efter utskrivning från sjukhus. Syfte: Syftet med den här litteraturstudien var att sammanställa tidigare kvalitativ forskning om patienters erfarenheter av rehabilitering efter amputation av nedre extremitet efter utskrivning från sjukhus. Metod: Scoping review. Resultat: Resultatet av den här studien byggde på tolv artiklar och fem huvudteman identifierades samt femton subteman. Studien visade bland annat på hur informationsbrist råder från sjukvårdspersonalen till patienten på olika nivåer och att tilliten till personalen är viktig. Bristande ekonomi minskade följsamheten till rehabiliteringen av olika anledningar, men har även en direkt korrelation till patientens överlevnad. Kostnaden för sjukvården beskrevs även som en fråga om liv och död där fri sjukvård var avgörande för socioekonomiskt utsatta grupper. Konklusion: Konklusionen belyste att partner och familj är viktiga för hur patienten tacklar själva rehabiliteringsprocessen. Därför är det viktigt att sjuksköterskan är lyhörd vid vårdövergång från sjukhus till hemmiljö eftersom vårdbördan för familjen ökar och patienten är som mest sårbar. / Background: Going through an amputation is a life-changing event followed by challenges physically and mentally for the affected person not least after discharge from hospital. Aim: The aim of this literature review was to compile previous qualitative research of patients’ experience of rehabilitation after amputation of lower extremity after discharge from hospital. Method: Scoping review. Result: Based on twelve scientific articles five main themes and fifteen subthemes were identified. This study illustrated how lack of information exists from healthcare professionals to the patient on different levels and trust towards the staff is important. Lack of financial resources reduced the adherence to rehabilitation and had a direct correlation to patient survival. The cost of medical care was described as a matter of life and death where free health care was crucial for socio-economically vulnerable groups. Conclusion: The conclusion illuminated the importance of the partner and family for how the patient deal with the rehabilitation process. It is important that the nurse is responsive when care transition occurs from hospital to home environment as the burden of care for the family increases and the patient is the most vulnerable.

BACKGROUND: In order to maintain non-weight bearing restrictions of the lower extremity, an assistive device must be utilized. Currently most devices require the restricted limb to be held in a static position while the contralateral extremity provides forward propulsion. Atrophy and disuse conditions ensue rapidly, slowing healing and prolonging recovery. A hands-free single crutch (HFSC) utilizes both lower extremities, potentially reducing atrophy. The purpose of this study was to examine the Electromyography (EMG) differences between a HFSC and standard axillary crutches (SAC). METHODS: A prospective, crossover study was performed using 21 healthy volunteers from an active duty foot and ankle clinic. Demographic data was obtained and then subjects were fitted with a HFSC and SAC. Wireless surface EMG sensors were applied to the belly of the rectus femoris (RF), vastus lateralis (VL), lateral gastrocnemius (LG), and the gluteus maximus (GM) by a board-certified orthopedic surgeon. Subjects then ambulated at a self-selected velocity for 30 meters, while 15 seconds of the gait cycle was recorded for each device. Mean muscle activity and the maximum voluntary isometric contraction (MVIC) were recorded. RESULTS: The RF, GM, and LG showed statistically significant increased levels of muscle activity while using the HFSC compared to SAC (respectively P = 0.05, P = 0.03, P = 0.03). The VL did not show statistically higher muscle activity while using the HFSC (P = 0.051). The RF, GM, and VL showed statistically significant higher MVIC percentages while using the HFSC compared to using SAC (respectively P = 0.005, P = 0.005, P = 0.013). The LG did not show statistically higher MVIC percentage while using the HFSC (P = 0.076). CONCLUSION: The HFSC subjects demonstrated increased muscle recruitment and intensity while maintaining cyclic contractions consistent with bipedal gait pattern. SAC demonstrated less recruitment and intensity with an isometric pattern regardless of the phase of gait. / 2022-06-04T00:00:00Z

Tai Chi Chuan is a safe alternative for those who wish to improve balance and physical wellbeing. It is a popular form of exercise that is supported by a growing body of research aimed towards improving the health of a sedentary elderly population. The purpose of this study was to examine the biomechanical features of the lower extremity during performance of two Tai Chi movements, the “Repulse Monkey (RM)” and “Wave-hands in clouds (WHIC).” The study’s parameters included quantitative measures of the temporospatial, kinematic, and kinetic characteristics of the lower extremities. A group of experienced male Tai Chi practitioners (n = 15) between the ages of 65 to 75, performed “Repulse Monkey (RM)”, “Wave-hand in Cloud (WHIC)”, and forward walking. Three-dimensional (3-D) kinematic and kinetic data was collected using VICON motion analysis system with 10 infrared cameras and 4 force plates. The following variables were examined: stride width, step length, step width, single- and double-support times, centre of mass (COM) displacement, peak joint angles, range of motion, peak joint moments, time to peak moment, and ground reaction force (GRF). The differences in the measurements of the two Tai Chi movements were compared with walking using two-way ANOVA. The study’s results showed that the two Tai Chi movements elicit gentle and fluid changes to position of the upper body mass and the joints in the lower extremity. In terms of joint kinematics, the knee remained flexed throughout RM and WHIC. Unlike walking, RM had larger abduction and adduction angles at the knee joints and large plantar- and dorsiflexion ROM at the ankle. Reduced posterior, mediolateral, and vertical GRF were seen; the loading joints at the ankle and hip were gentle and smaller than walking. Varus/valgus moments were notably larger at the knee joint during RM and eversion moment was larger at the ankle joint during WHIC movement. A large, but slow loading rate at the knee joint has implication towards the viscoelastic properties of the knee. A better understanding of RM and WHIC would facilitate the improvement of balance, physical capacity, and joint flexibility for the elders.

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Bakgrund: Protesen har existerat sedan forntida egypten. Att leva med en protes kan ha både negativ och positiv påverkan hos protesbäraren. Omställningen bidrar till en ny livsstil där varje individ kan påverkas i olika utsträckning både psykiskt och fysiskt. Sjuksköterskan behöver ha kunskap om protesbärarens upplevelser för att kunna hjälpa protesbäraren att anpassa sig till livet med en protes. Syfte: Syftet med studien var att belysa upplevelser av att leva med en protes för nedre extremitet. Metod: Allmän litteraturstudie bestående av tio resultatartiklar som söktes fram i databaserna CINAHL, PubMed, PsycINFO samt Sage Journals. Artiklarna analyserades med hjälp av en guide för kvalitativ forskning gjord av Popenoe et al. (2021). Resultat: Det framkom fem kategorier och dessa var: rörlighet, komfort och funktion, samhällets inverkan, utbildning, jobb och ekonomi och socialt stöd. Alla kategorier belyste hur det kan vara att leva med en protes för nedre extremitet. Konklusion: Protesen kan medföra en känsla av självständighet samtidigt som den kan upplevas som en begränsning med smärtor och problem med passform. Stöd från anhöriga och vårdpersonal var viktigt för återhämtningen. Att vårdpersonal gav god och tillräcklig information var också väsentligt. Ytterligare forskning behövs om protesbärares upplevelser av att leva med en protes för nedre extremitet där sjuksköterskor får den kunskap som krävs för att ge en god omvårdnad. / Background: The prosthesis has existed since ancient Egypt. Living with a prosthesis can have both negative and positive effects on the prosthesis user. The transition contributes to a new lifestyle where each individual can be affected to different extents both psychologically and physically. The nurse needs to have knowledge about the experiences of a prosthesis user in order to be able to help the prosthesis user adapt to life with a prosthesis. Aim: The aim of the study was to illustrate experiences of living with a lower extremity prosthesis. Method: The general literature review study included ten result articles that were searched in the databases CINAHL, PubMed, PsycINFO and Sage Journals. The articles were analyzed using a guide for qualitative research made by Popenoe et al. (2021). Results: Five categories emerged and these were: mobility, comfort and function, impact from the society, education, jobs and finances and social support. All categories highlighted what it can be like to live with a prosthesis for the lower limb. Conclusion: The prosthesis can bring a sense of independence as well as a limitation that includes pain and problems with the fitting of the prosthesis. Support from relatives and healthcare professionals was important for the recovery. It was also essential that healthcare staff provided good and sufficient information to the patient. Further research is needed on prosthesis users’ experiences of living with a lower extremity prosthesis where nurses gain the knowledge required to provide good nursing care.

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