The psychometric properties of a new high-level mobility outcome measure for Service Members (SMs) with traumatic lower limb loss called the Comprehensive High-level Activity Mobility Predictor (CHAMP) was developed in order objectively evaluate functional abilities and measure change in function throughout the rehabilitation process. The CHAMP was administered to a population of SMs with traumatic lower limb loss who were representative of those who have suffered limb loss in recent conflicts. In addition, a population of non-amputee Active Duty soldiers completed the CHAMP and provided normative data for high-level mobility and threshold levels of performance for those SMs with lower limb loss. A simple grading system, absent of floor and ceiling effects, generates a composite score providing a single numeric value representing the physical performance factors of high-level mobility in different plane of motion and under different conditions. The CHAMP was found to be a safe, reliable, valid, and responsive performance-based outcome measure of high-level mobility. It was found to have excellent interrater and test-retest reliability suggesting that it is a stable and repeatable measure of high-level mobility. Convergent construct validity and known group methods were utilized to establish the CHAMP as a valid measure of high-level mobility. Predictive models of CHAMP performance were established utilizing variables representing impairments of body structure and function and contextual factors by level of lower limb amputation. The CHAMP has the potential to be used for lower limb amputees throughout the rehabilitation process and could translate to the non-amputee population for assessment of high-level mobility capabilities.

A presente pesquisa teve por objetivo a geração de diretrizes de projeto para o desenvolvimento de Próteses de Membros Inferiores, que atendesse as necessidades funcionais dos usuários que resulte na simplificação do objeto. Para isso, investigou-se o usuário, percebendo suas necessidades físicas e psicológicas, com conhecimento de leis federais existentes para o auxílio a esse público. Também, foram examinados a anatomia humana e os procedimentos cirúrgicos para a amputação de membros inferiores, a fim de compreender sua influência na concepção de uma prótese. Outro enfoque da pesquisa foi o estudo da biomecânica para reconhecer os movimentos realizados por uma pessoa sadia durante a deambulação, observando-se as etapas da sua marcha em comparação à marcha de indivíduos amputados que utilizavam próteses. Ainda foram analisados distintos tipos de próteses de membros inferiores e a tecnologia empregada em cada uma de suas partes: sistema de encaixe ao coto, joelho protético e sistema pé-tornozelo. Esses estudos originaram dados empregados na aplicação da metodologia do Design for X, para avaliar as próteses atuais em seus aspectos e construção, com o objetivo de gerar diretrizes de projeto para a elaboração de próteses simplificadas. Constatou-se que a aplicação do método originou diretrizes de projeto que poderão ser empregados durante o desenvolvimento de projetos de próteses de membros inferiores, visando à redução de custo do produto. / This research aims to generate design requirements for the development of Lower Limb Prosthetics that meet the functional needs of users, leading to a simplification of the object. For this, we investigated the users regarding their physical and psychological needs, with full knowledge of the existence of federal laws in order to help people. Human anatomy and surgical procedures for lower limb amputation were also examined in order to understand their influence on the design of a prosthesis. Another focus of the research was the study of biomechanics to recognize the movements performed by a healthy person when walking, observing the steps of their march comparing them with the march of amputees who used prosthesis. For the simplified development of prosthesis different types of prosthetic legs have been examined, technology has been employed in each of its parts such as fitting the stump prosthetic knee and the ankle-foot system. These studies yielded useful data used in the application of the methodology of Design for X to assess current prosthetic aspects and construction, to achieve design requirements for the development of simplified prosthesis. It was found that the application of the method originated design requirements that may be employed during the development of lower limb prosthesis projects, aiming to reduce product cost.

Introdução: Atletas de Powerlifting utilizam habitualmente em sua preparação física o Agachamento (AT) e o Box-Squat (BS). Conhecer as variáveis cinemáticas e eletromiográficas destes exercícios é relevante para sua prescrição. Objetivo: Comparar os efeitos agudos da utilização do Agachamento e do Box-Squat, em três diferentes amplitudes de movimento, sobre variáveis de desempenho neuromuscular, em atletas de Powerlifting. Materiais e Métodos: Dez atletas de Powerlifing (31,7±5,05 anos) participaram de duas sessões de avaliação: i) aplicação de questionário, realização de medidas antropométricas e testes de 1RM para Agachamento e Box-Squat nas condições Completo, Paralelo e Parcial; ii) Coleta do sinal eletromiográfico dos músculos Reto Femoral; Vasto Lateral; Vasto Medial; Bíceps Femoral; Glúteo Máximo; Gastrocnêmio Lateral e Eretores da Coluna, durante AT e BS com as cargas de 1RM previamente aferidas. Coleta de dados de cinemetria 2D para o cálculo da Potência Absoluta e Relativa. Resultados: A carga de 1RM (252±55 Kg) e o Índice de Força Relativa (2,66±0,43) do BS Parcial foram significativamente maiores que nas outras cinco variações de exercício. Potência Absoluta (613,25±194,80 W) e Relativa (6,48±1,86) foram maiores no AT Parcial quando comparado a BS Completo, AT Completo, AT Paralelo e BS Paralelo. A ativação EMG do Reto Femoral foi maior no BS Completo (95,48±46,82 %CIVM) comparada à AT Parcial e BS Parcial. O Glúteo Máximo foi mais ativado no AT Paralelo (175,36±101,79 %CIVM) comparado ao BS Completo (143,51±79,00 %CIVM). A ativação dos Eretores da Coluna no AT Paralelo (132,27±77,31 %CIVM) foi superior à do AT Parcial (92,09±38,28 %CIVM). Conclusão: As cargas de 1RM foram maiores em excursões articulares reduzidas, com vantagem do BS Parcial. O AT Parcial apresentou maiores valores de Potência Absoluta e Relativa. AT e BS mostraram-se equivalentes do ponto de vista da ativação muscular. / Introduction: Powerlifters commonly use Squats and Box-Squats in their training process. Knowing kinetics and kinematics of these exercises can help trainers when planning a training program. Objective: To compare kinetic and kinematics of full, parallel and partial Squats and Box-Squats performed by Powerlifters. Material and Methods: Ten Powerlifters (31,7±5,05 years) participated in two sessions of data collection: i) Survey about training and injury, Anthropometrical measures, 1RM testing for the full, parallel and partial Squats and Box-Squats; ii) Muscle activity of rectus femoris, vastus lateralis, vastus medialis, biceps femoris, gluteus maximus, lateral gastrocnemius and erector spinae over the six conditions at 100% of 1RM. Sagital plane video was recorded for power output measures. Results: Significantly higher loads were observed in Partial Box-Squat (252±55 Kg) compared to the other five situations. Overall (613,25±194,80 W) and Relative (6,48±1,86) Power Output were higher at Partial Squat when compared to Parallel and Full Squats and Box-Squats. Muscle activation of rectus femoris was significantly higher in Full Box-Squat (95,48±46,82 %MVC) compared to Partial Squats and Box-Squats. Gluteus maximus activation was higher at the Parallel Squat (175,36±101,79 %MVC) when compared to the Full Box-Squat (143,51±79,00 %MVC). Erector Spinae muscle activation was significantly higher in Parallel Squat (132,27±77,31 %MVC) in comparison to the Partial Squat (92,09±38,28 %MVC). Conclusion: Higher 1RM loads were found in Partial Range of Motion, especially in Box-Squat. Overall and Relative Power Output were higher at Partial Squats. Squats and Box-Squats showed similar muscle activation patterns.

This thesis deals with the issue of patients after the amputation of the lower limb. Loss of the lower limb means a great change for the patient, not only in understanding the integrity of one's own body, one's own health, but also from a functional point of view. The theoretical part of the thesis presents the latest available knowledge about lower limb amputation and postoperative care for patients with this diagnosis. It also deals with self-care, based on Dorotheus Orem's theory of self-care deficit. The aim of the work was to determine the level of self-care of patients after amputation of the lower limb using some aspects of D. E. Orem's model. To find out in what systems D.E. Orem's nurses support patients after the amputation of the lower limb in self-care and how to help nurses care for these patients. The research part of the thesis was realized through a qualitative research survey. The technique of data collection was a semi-structured interview with patients with amputation of the lower limb and nurses who provide nursing care for such ill persons. The theoretical basis for the interview was the DE Oremové model, which was complemented by the ADL (Activity Daily Living), IADL (Instrumental Activities of Daily Living Scale) and the analogue range of pain in the group of respondents - patients. The data obtained were processed in the form of transcripts of the interviews, which are supplemented by evaluation of individual scales. The output of the diploma thesis is a set of recommended measures and a proposal of a comprehensive information material on the amputation of the lower limb for patients, which the nurses should be available to their departments.

abstract: Lower-limb prosthesis users have commonly-recognized deficits in gait and posture control. However, existing methods in balance and mobility analysis fail to provide sufficient sensitivity to detect changes in prosthesis users' postural control and mobility in response to clinical intervention or experimental manipulations and often fail to detect differences between prosthesis users and non-amputee control subjects. This lack of sensitivity limits the ability of clinicians to make informed clinical decisions and presents challenges with insurance reimbursement for comprehensive clinical care and advanced prosthetic devices. These issues have directly impacted clinical care by restricting device options, increasing financial burden on clinics, and limiting support for research and development. This work aims to establish experimental methods and outcome measures that are more sensitive than traditional methods to balance and mobility changes in prosthesis users. Methods and analysis techniques were developed to probe aspects of balance and mobility control that may be specifically impacted by use of a prosthesis and present challenges similar to those experienced in daily life that could improve the detection of balance and mobility changes. Using the framework of cognitive resource allocation and dual-tasking, this work identified unique characteristics of prosthesis users’ postural control and developed sensitive measures of gait variability. The results also provide broader insight into dual-task analysis and the motor-cognitive response to demanding conditions. Specifically, this work identified altered motor behavior in prosthesis users and high cognitive demand of using a prosthesis. The residual standard deviation method was developed and demonstrated to be more effective than traditional gait variability measures at detecting the impact of dual-tasking. Additionally, spectral analysis of the center of pressure while standing identified altered somatosensory control in prosthesis users. These findings provide a new understanding of prosthetic use and new, highly sensitive techniques to assess balance and mobility in prosthesis users. / Dissertation/Thesis / Doctoral Dissertation Biomedical Engineering 2017

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: Patellofemoral pain syndrome (PFPS) is a condition that affects young women and it can contribute to lower limb functionality reduction. However, while some studies demonstrate functional alterations related to this syndrome, others do not find this difference between individuals with and without this condition. Objectives: To evaluate and compare the level of pain and functionality, muscular recruitment, joint position sense and dynamic postural control between young women with and without PFPS. Metodologia: 12 women with PFPS (21.67 ± 2.49 of age) and 12 controls (21.25 ± 2.01) participated in this study. Self-perceived knee functionality was assessed by Lysholm Knee Scoring Scale and the level of pain by Visual Analogue Scale (VAS). Electromyography (EMG) evaluated lateral gastrocnemius, soleus (SO), tibialis anterior, vastus medialis oblique (VMO), vastus medialis longus, vastus lateralis (VL) and bíceps femoris muscles during stair ascent and descent of different heights (5 e 15cm), the results was analyzed in 3 phases. Joint position sense was assessed by electrogoniometer and dynamic postural control was assessed by the Star Excursion Balance Test (SEBT).. Statistic analyzes compared the two groups by student t for independent samples and Mann-Whitney tests. The results are expressed as mean ± standard deviation. Results: There was difference (p<0,001) between groups in VAS (SDFP: 5,08 ± 1,98, GC: 0 ± 0,0;) and Lysholm Scale (GC: 99,62 ± 1,38, SDFP: 68,33 ± 16,08). Just the phase 1 (p=0,041) and 3 (p=0,035) of soleus muscle showed difference during descent of 5cm step. Phase 2 of VL (p=0,020), 3 of VMO (p=0,005) and VL (p=0,016) also showed difference during ascent of 15 cm step. There was no difference (p>0,05) between groups in joint position sense and SEBT. Conclusion: Women with PFPS report higher pain and lower knee functionality than controls. However, they do not demonstrate altered joint position sense and dynamic postural control, and could need of higher quadriceps recruitment during stair ascent. / Introdução: A Síndrome da Dor Femoropatelar (SDFP) é uma condição que afeta mulheres jovens e pode contribuir para a redução da funcionalidade do membro inferior. Entretanto, enquanto alguns estudos demonstram alterações funcionais relacionadas à SDFP, outros não encontram diferenças entre portadores e não portadores. Objetivos: Avaliar e comparar o nível de dor, funcionalidade, o recrutamento muscular, o senso de posição articular e o controle postural dinâmico entre mulheres jovens portadoras e não portadoras da SDFP. Metodologia: 12 mulheres com SDFP (21,67 ± 2,49 anos de idade) e 12 controles (21,25 ± 2,01) participaram do estudo. A autopercepção da funcionalidade do joelho foi acessada pelo questionário de Lysholm e o nível de dor por meio da Escala Visual Analógica (EVA). Foi realizada a eletromiografia (EMG) dos músculos gastrocnêmico lateral, sóleo (SO), tibial anterior, vasto medial oblíquo (VMO), vasto medial longo, vasto lateral (VL) e bíceps femoral durante a subida e descida de dois degraus de alturas diferentes (5 e 15cm), os resultados foram analisados em 3 fases dinstintas. A avaliação do senso de posição articular foi realizada por meio do eletrogoniômetro e o controle postural dinâmico por meio do Star Excursion Balance Test (SEBT). A análise estatítisca comparou os dois grupos por meio dos testes t de student para amostras independentes e Mann-Whitney. Os resultados foram expressos como média ± desvio padrão. Resultados: Houve diferença (p<0,001) entre os grupos na EVA (SDFP: 5,08 ± 1,98, GC: 0 ± 0,0;) e no questionário de Lysholm (GC: 99,62 ± 1,38, SDFP: 68,33 ± 16,08). Apenas a fase 1 (p=0,041) e fase 3 (p=0,035) do músculo SO apresentou diferença na decida do degrau de 5cm, e a fase 2 do VL (p=0,020), fase 3 do VMO (p=0,005) e VL (p=0,016) na subida do degrau de 15 cm. Não houve diferença significativa (p>0,05) no senso de posição articular e SEBT. Conclusão: Mulheres com SDFP relatam maior dor e menor funcionalidade na articulação do joelho. Entretanto, as mesmas não possuem senso de posição articular e controle postural dinâmico alterado, mas podem necessitar de maior recrutamento do quadríceps durante a subida de degraus. / Mestre em Ciências da Saúde

Introdução: Atletas de Powerlifting utilizam habitualmente em sua preparação física o Agachamento (AT) e o Box-Squat (BS). Conhecer as variáveis cinemáticas e eletromiográficas destes exercícios é relevante para sua prescrição. Objetivo: Comparar os efeitos agudos da utilização do Agachamento e do Box-Squat, em três diferentes amplitudes de movimento, sobre variáveis de desempenho neuromuscular, em atletas de Powerlifting. Materiais e Métodos: Dez atletas de Powerlifing (31,7±5,05 anos) participaram de duas sessões de avaliação: i) aplicação de questionário, realização de medidas antropométricas e testes de 1RM para Agachamento e Box-Squat nas condições Completo, Paralelo e Parcial; ii) Coleta do sinal eletromiográfico dos músculos Reto Femoral; Vasto Lateral; Vasto Medial; Bíceps Femoral; Glúteo Máximo; Gastrocnêmio Lateral e Eretores da Coluna, durante AT e BS com as cargas de 1RM previamente aferidas. Coleta de dados de cinemetria 2D para o cálculo da Potência Absoluta e Relativa. Resultados: A carga de 1RM (252±55 Kg) e o Índice de Força Relativa (2,66±0,43) do BS Parcial foram significativamente maiores que nas outras cinco variações de exercício. Potência Absoluta (613,25±194,80 W) e Relativa (6,48±1,86) foram maiores no AT Parcial quando comparado a BS Completo, AT Completo, AT Paralelo e BS Paralelo. A ativação EMG do Reto Femoral foi maior no BS Completo (95,48±46,82 %CIVM) comparada à AT Parcial e BS Parcial. O Glúteo Máximo foi mais ativado no AT Paralelo (175,36±101,79 %CIVM) comparado ao BS Completo (143,51±79,00 %CIVM). A ativação dos Eretores da Coluna no AT Paralelo (132,27±77,31 %CIVM) foi superior à do AT Parcial (92,09±38,28 %CIVM). Conclusão: As cargas de 1RM foram maiores em excursões articulares reduzidas, com vantagem do BS Parcial. O AT Parcial apresentou maiores valores de Potência Absoluta e Relativa. AT e BS mostraram-se equivalentes do ponto de vista da ativação muscular. / Introduction: Powerlifters commonly use Squats and Box-Squats in their training process. Knowing kinetics and kinematics of these exercises can help trainers when planning a training program. Objective: To compare kinetic and kinematics of full, parallel and partial Squats and Box-Squats performed by Powerlifters. Material and Methods: Ten Powerlifters (31,7±5,05 years) participated in two sessions of data collection: i) Survey about training and injury, Anthropometrical measures, 1RM testing for the full, parallel and partial Squats and Box-Squats; ii) Muscle activity of rectus femoris, vastus lateralis, vastus medialis, biceps femoris, gluteus maximus, lateral gastrocnemius and erector spinae over the six conditions at 100% of 1RM. Sagital plane video was recorded for power output measures. Results: Significantly higher loads were observed in Partial Box-Squat (252±55 Kg) compared to the other five situations. Overall (613,25±194,80 W) and Relative (6,48±1,86) Power Output were higher at Partial Squat when compared to Parallel and Full Squats and Box-Squats. Muscle activation of rectus femoris was significantly higher in Full Box-Squat (95,48±46,82 %MVC) compared to Partial Squats and Box-Squats. Gluteus maximus activation was higher at the Parallel Squat (175,36±101,79 %MVC) when compared to the Full Box-Squat (143,51±79,00 %MVC). Erector Spinae muscle activation was significantly higher in Parallel Squat (132,27±77,31 %MVC) in comparison to the Partial Squat (92,09±38,28 %MVC). Conclusion: Higher 1RM loads were found in Partial Range of Motion, especially in Box-Squat. Overall and Relative Power Output were higher at Partial Squats. Squats and Box-Squats showed similar muscle activation patterns.

A presente pesquisa teve por objetivo a geração de diretrizes de projeto para o desenvolvimento de Próteses de Membros Inferiores, que atendesse as necessidades funcionais dos usuários que resulte na simplificação do objeto. Para isso, investigou-se o usuário, percebendo suas necessidades físicas e psicológicas, com conhecimento de leis federais existentes para o auxílio a esse público. Também, foram examinados a anatomia humana e os procedimentos cirúrgicos para a amputação de membros inferiores, a fim de compreender sua influência na concepção de uma prótese. Outro enfoque da pesquisa foi o estudo da biomecânica para reconhecer os movimentos realizados por uma pessoa sadia durante a deambulação, observando-se as etapas da sua marcha em comparação à marcha de indivíduos amputados que utilizavam próteses. Ainda foram analisados distintos tipos de próteses de membros inferiores e a tecnologia empregada em cada uma de suas partes: sistema de encaixe ao coto, joelho protético e sistema pé-tornozelo. Esses estudos originaram dados empregados na aplicação da metodologia do Design for X, para avaliar as próteses atuais em seus aspectos e construção, com o objetivo de gerar diretrizes de projeto para a elaboração de próteses simplificadas. Constatou-se que a aplicação do método originou diretrizes de projeto que poderão ser empregados durante o desenvolvimento de projetos de próteses de membros inferiores, visando à redução de custo do produto. / This research aims to generate design requirements for the development of Lower Limb Prosthetics that meet the functional needs of users, leading to a simplification of the object. For this, we investigated the users regarding their physical and psychological needs, with full knowledge of the existence of federal laws in order to help people. Human anatomy and surgical procedures for lower limb amputation were also examined in order to understand their influence on the design of a prosthesis. Another focus of the research was the study of biomechanics to recognize the movements performed by a healthy person when walking, observing the steps of their march comparing them with the march of amputees who used prosthesis. For the simplified development of prosthesis different types of prosthetic legs have been examined, technology has been employed in each of its parts such as fitting the stump prosthetic knee and the ankle-foot system. These studies yielded useful data used in the application of the methodology of Design for X to assess current prosthetic aspects and construction, to achieve design requirements for the development of simplified prosthesis. It was found that the application of the method originated design requirements that may be employed during the development of lower limb prosthesis projects, aiming to reduce product cost.

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

A presente pesquisa teve por objetivo a geração de diretrizes de projeto para o desenvolvimento de Próteses de Membros Inferiores, que atendesse as necessidades funcionais dos usuários que resulte na simplificação do objeto. Para isso, investigou-se o usuário, percebendo suas necessidades físicas e psicológicas, com conhecimento de leis federais existentes para o auxílio a esse público. Também, foram examinados a anatomia humana e os procedimentos cirúrgicos para a amputação de membros inferiores, a fim de compreender sua influência na concepção de uma prótese. Outro enfoque da pesquisa foi o estudo da biomecânica para reconhecer os movimentos realizados por uma pessoa sadia durante a deambulação, observando-se as etapas da sua marcha em comparação à marcha de indivíduos amputados que utilizavam próteses. Ainda foram analisados distintos tipos de próteses de membros inferiores e a tecnologia empregada em cada uma de suas partes: sistema de encaixe ao coto, joelho protético e sistema pé-tornozelo. Esses estudos originaram dados empregados na aplicação da metodologia do Design for X, para avaliar as próteses atuais em seus aspectos e construção, com o objetivo de gerar diretrizes de projeto para a elaboração de próteses simplificadas. Constatou-se que a aplicação do método originou diretrizes de projeto que poderão ser empregados durante o desenvolvimento de projetos de próteses de membros inferiores, visando à redução de custo do produto. / This research aims to generate design requirements for the development of Lower Limb Prosthetics that meet the functional needs of users, leading to a simplification of the object. For this, we investigated the users regarding their physical and psychological needs, with full knowledge of the existence of federal laws in order to help people. Human anatomy and surgical procedures for lower limb amputation were also examined in order to understand their influence on the design of a prosthesis. Another focus of the research was the study of biomechanics to recognize the movements performed by a healthy person when walking, observing the steps of their march comparing them with the march of amputees who used prosthesis. For the simplified development of prosthesis different types of prosthetic legs have been examined, technology has been employed in each of its parts such as fitting the stump prosthetic knee and the ankle-foot system. These studies yielded useful data used in the application of the methodology of Design for X to assess current prosthetic aspects and construction, to achieve design requirements for the development of simplified prosthesis. It was found that the application of the method originated design requirements that may be employed during the development of lower limb prosthesis projects, aiming to reduce product cost.