As progressivas inovações tecnológicas na área de engenharia mecânica contribuem para a adoção de novos procedimentos terapêuticos para programas de reabilitação. Este trabalho trata do projeto e desenvolvimento de um auxiliar deambulatório para ser utilizado como uma forma de dar continuidade à reabilitação clínica de pessoas com dificuldade ou incapacidade na marcha independente. Nesse sentido, procurou-se desenvolver um deambulador incorporando novas abordagens ao seu projeto mecânico básico, tais como novos materiais, fabricação e conformação da estrutura mecânica, bem como possíveis controles de mobilidade articulares. Nesse contexto, a relação peso-volume foi cuidadosamente explorada de forma a tornar um auxiliar eficiente na marcha de crianças e adultos com paralisia cerebral. Os deambuladores convencionais hodiernos são fundamentalmente caracterizados pelo nível de segurança proporcionada aos usuários em movimento, todavia não oferecem condições para o treino do autoequilíbrio, o que os torna dependentes de ferramentas de auxílio para a realização correta da marcha. Portanto, é importante desenvolver um deambulador autotransferente que satisfaça as restrições de projeto, com volume e peso mínimos, e que seja essencial para a reabilitação de pacientes com paralisia cerebral, sem torná-los dependentes pela ausência do autoequilíbrio. Esse equipamento promove a autotransferência e o treinamento do autoequilíbrio do usuário seja ele adulto ou criança. Neste projeto, o deambulador foi denominado de Auxiliar Deambulatório Autotransferente - ADA devido à ação recíproca da marcha que transfere o torque muscular do tronco inferior para a mobilização dos membros inferiores. Assim, o ADA poderá fornecer situações sinestésicas nas quais o autoequilíbrio do paciente será estimulado a se manifestar. Com isso, o paciente poderá estar apto para adquirir ou recuperar o autoequilíbrio e a confiança para efetuar o treino da marcha. / The progressive technological innovations in mechanical engineering contribute to the adoption of new therapeutic procedures for rehabilitation programs. This work addresses the design and development of an ambulatory aid to be used as a way to continue the clinic rehabilitation for people with difficulty or inability in walking independently. Accordingly, we sought to develop a deambulador incorporating new approaches to its basic mechanical design, such as new materials, manufacturing and conformation of the mechanical structure and possible controls of joint mobility. In this context, the volume-weight ratio has been carefully explored in order to make an assist in the efficient running of children and adults with cerebral palsy. The conventional modern-day ambulatory are fundamentally characterized by the level of security provided to users on the move, but do not offer conditions for the auto balance training, which makes them dependent on aid tools to achieve the correct gait. It is therefore important to develop an autotransfer deambulator satisfying the design constraints, with minimum volume and weight, and with the essential characteristic for the rehabilitation of patients with cerebral palsy, without making them dependent on the absence of auto balance. This apparatus that promotes autotransfer and training of auto balance for the user whether adult or child. In this project the deambulador was named Assistant Deambulator Autotransfer (Auxiliary Ambulation Autotransfer) - ADA due to the interplay of movement, which transfers the torque of the lower trunk muscles for the mobilization of the lower limbs. Thus, the ADA may provide situations in which the synaesthetic auto balance the patient will be encouraged to carry out. Thus, the patient may be able to acquire or retrieve the auto balance and confidence to make the training of the march.

Abnormal lumbar movement has been observed in individuals who have a history of low back pain (LBP). Affected individuals display a reduction in lumbar spine rotation during trunk movement tasks, while pelvic rotation increases to compensate. Reduced lumbar contribution to forward bending is associated with increased compressive forces and increased shearing demand of the task on the lower back. This abnormal lumbo-pelvic coordination (LPC) can persist beyond LBP symptom alleviation and may contribute to further occurrences or more severe cases of LBP. This study serves as a first step in investigating if abnormal LPC can be corrected with a hip orthosis by examining the effects of the device on the LPC of healthy individuals. Twenty participants without presence or history of LBP were recruited to participate in a repeated measures study, completing trunk motion tasks with and without a hip orthosis. In a random order, participants completed forward bending and backward return, lateral bending to the left and right, and axial twisting to the left and right. Thoracic, lumbar, and pelvic rotation along with lumbar-thoracic ratio (LTR) were calculated for each of the movement tasks. Thoracic rotation (total trunk movement) was not significantly altered (p > 0.05, F=0.633) by the application of the hip orthosis. LTR was significantly increased (p < 0.001, F=2.96) with the orthosis by 32%, 22%, 12%, 4%, and 12% for axial twisting left, axial twisting right, lateral bending left, lateral bending right, and forward bending, respectively. This indicates lumbar contributions were increased by physically restricting the pelvis. The effects of a hip orthosis should be further investigated in LBP patients to verify correction of an abnormal LPC.

No description available.

Chronic lateral instability of the ankle (CLI), defined as frequent sprains and recurrent giving way, difficulty in walking and running on uneven surface, is often connected with pain and swollen ankles. It occurs in 10 to 20 percent after acute ankle injuries. Mechanical instability of the talocrural and subtalar joint, peroneal weakness and impaired proprioception has been suggested as etiological factors. Aim. To investigate the natural course in conservatively treated patients with CLI. To assess the mechanical stability in patients with CLI by measuring the three dimensional motions in the talus, the fibula and the calcaneus in relation to the tibia during different testing procedures pre- and postoperatively. To determine if CLI is associated with proprioceptive deficiency. Patients and Methods. This Thesis includes 127 ankles in 78 patients (30 women, 48 men) with CLI. Thirty-seven patients were followed up 20 years after their first contact with the orthopaedic department because of CLI. Forty-six ankles were evaluated radiographically and the result was compared with a gender- and age - matched control-material. The neuromuscular response to a sudden angular displacement of the ankles was studied in 15 ankles in 13 patients using EMG. Thirty-six patients entered a prospective study using roentgen stereophotogrammetric analysis (RSA) in which the ankles were tested at manual adduction, adduction with predetermined torque, with and without external support and at drawer tests (40 N and 160N). Twenty-seven patients were followed five years postoperatively. Result. After 20 years 22 patients, conservatively treated still suffered from instability of the ankle and ten had recurrent giving way symptoms even on plane surface. Six ankles in the patient group and four in the control group displayed osteoarthritic changes Prolonged ipsilateral reaction time (m. per. long, and m. tib. ant.) was found in patients with CLI indicating proprioceptive insufficiency. Increased talar adduction and a tendency toward increased total translation of the talar center was found in ankles with CLI. Concomitant fibular rotations and translations were found but with no conclusive deviation in the ankles with symptoms. The talo-calcaneal adduction reached the same level in the patient and control groups regardless of symptoms. External support (ankle brace) increased the talar stability. The use of predetermined torque and constrained testing procedure did not add information compared with the manual test Twenty-five patients graded the result as excellent or good five years after lateral ligament reconstruction. Talar stability (decreased adduction and translation) was increased two years postoperatively and was improved or remained the same at five years without comprising the range of motion. Conclusion. In more than half the cases symptoms of CLI did not resolve spontaneously. Minor degenerative changes was found after twenty years, but not to a greater extent than in a control group. CLI was associated with proprioceptive insufficiency and talocrural but not subtalar instability. Increased ankle stability can be obtained by the use of an ankle brace and by an anatomical ligament reconstruction. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1994</p> / digitalisering@umu

Aim: The overall aim of this thesis was to generate further knowledge about prosthetic and orthotic services in developing countries. In particular, the thesis focused on patient mobility and satisfaction with prosthetic and orthotic devices, satisfaction with service delivery, and the views of staff regarding clinical practice and education. Methods: Questionnaires, including QUEST 2.0, were used to collect self-reported data from 83 patients in Malawi and 139 patients in Sierra Leone. In addition, 15 prosthetic/orthotic technicians in Sierra Leone and 15 prosthetists/orthotists in Pakistan were interviewed. Results: The majority of patients used their prosthetic or orthotic devices (90% in Malawi, and 86% in Sierra Leone), but half of the assistive devices in use needed repair. Approximately one third of patients reported pain when using their assistive device (40% in Malawi and 34% in Sierra Leone). Patients had difficulties, or could not walk at all, with their prosthetic and/or orthotic device in the following situations; uneven ground (41% in Malawi and 65% in Sierra Leone), up and down hills (78% in Malawi and 75% in Sierra Leone), on stairs (60% in Malawi and 66% in Sierra Leone). Patients were quite satisfied or very satisfied with their assistive device (mean 3.9 in Malawi and 3.7 in Sierra Leone out of 5) and the services provided (mean 4.4 in Malawi and 3.7 in Sierra Leone out of 5), (p&lt;0.001), but reported many problems (418 comments made in Malawi and 886 in Sierra Leone). About half of the patients did not, or sometimes did not, have the ability to access services (71% in Malawi and 40% in Sierra Leone). In relation to mobility and service delivery, orthotic patients and patients using above-knee assistive devices in Malawi and Sierra Leone had the poorest results. In Sierra Leone, women had poorer results than men. The general condition of devices and the ability to walk on uneven ground and on stairs were associated with both satisfaction of assistive devices and service received. Professionals’ views of service delivery and related education resulted in four themes common to Sierra Leone and Pakistan: 1) Low awareness and prioritising of prosthetic and orthotic services; 2) Difficulty managing specific pathological conditions and problems with materials; 3) The need for further education and desire for professional development; 4) Desire for improvements in prosthetic and orthotic education. A further two themes were unique to Sierra Leone; 1) People with disabilities have low social status; 2) Limited access to prosthetic and orthotic services. Conclusion: High levels of satisfaction and mobility while using assistive devices were reported in Malawi and Sierra Leone, although patients experienced pain and difficulties when walking on challenging surfaces. Limitations to the effectiveness of assistive devices, poor comfort, and limited access to follow-up services and repairs were issues that needed to be addressed. Educating prosthetic and orthotic staff to a higher level was considered necessary in Sierra Leone. In Pakistan, prosthetic and orthotic education could be improved by modifying programme content, improving teachers’ knowledge, improving access to information, and addressing issues of gender equality.

An orthosis, or orthotic device is used to straighten or correct the posture of part of the body. A foot orthosis (FO) is the subject of study for this dissertation. A FO is situated between the foot and the midsole of the shoe and replaces the insole. Foot orthoses (FOs) are intended to prevent or aid in the recovery of injury by acting to redistribute pressure experienced by the plantar surface of the foot as well as cause adjustments to the relative positions of the foot's bones during standing and gait. Traditional methods for developing a FO require extensive skilled manual labour and are highly dependent on subjective input. Modern FO development methods have sought to address these issues through the use of computer driven technological advancements. Foot scanners record geometry, computer aided design (CAD) software is used to develop the FO geometry, and automated manufacturing tools are used to either fabricate the FO or fabricate a mould about which the FO can be formed. A variety of modern solutions have successfully automated the process, however, it remains highly subjective. Skilled manual labour has merely been replaced with equally subjective skilled computer labour. In particular, adjustments to the foot are made with basic deformation functions to the static surface foot models generated by modern digitizers. To improve upon this, a model that describes the mechanics and properties of the various tissues of the foot is required. Such a model will also be useful for validating and optimizing FO designs prior to fabrication through simulation of weight-bearing conditions. Given the deformable characteristics of the tissues of the foot, the finite element (FE) modeling method is appropriate. The FE foot model has become a common medical and engineering tool in recent years. Its application, however, has primarily been limited to research as few clinical applications warrant the development cost. High cost stems from the MRI or CT scan and the skilled labour required to assemble the model for FE analysis. Consequently, the FE modeling approach has previously been out of reach for the application of FO development. The solution proposed and implemented was to map a detailed generic FE foot model to an inexpensive surface scan obtained from a modern digitizer. The mapping accurately predicted anatomical geometry and resulted in simulation models that can be used in the FO development process first to carry out postural adjustments prescribed by a practitioner and second in a validation step where a FO design can be tested prior to fabrication. In addition to simulation tools, novel complementary tools were developed for designing and fabricating FOs. The simulation, design, and fabrication tools were incorporated into a novel, seven step FO development process. The proposed process is beneficial to FO development as it reduces the required subjective input from practitioners and lab technicians and allows for the validation of potential FO designs prior to fabrication. Future work is required to improve computational efficiency of the FE foot models and to fully automate the process to make it commercially viable. In addition to FOs, the proposed approach also presents opportunities for improving other orthoses and prostheses for the human body.

After a stroke, gait and balance are often affected and an orthosis is typically required to facilitate postural control. This study has been conducted to examine how the Range of Motion in an Ankle-Foot-Orthosis (AFO) impacts on stroke patients’ dynamic balance. It was hypothesized that better dynamic balance would be recorded when individuals were wearing a flexible AFO. The tests that was used in this study were the Timed Up and Go test (TUG), and the Center of Pressure (CoP)/Center of Mass (CoM) inclination angle, both in Anterior-Posterior (AP) and Medio-Lateral (ML) planes. The three patients participating in this study were all users, or had been users of AFO’s, and during the study they were asked to wear a customized AFO with the possibility to change the settings to open, flexible and rigid ankle joints. The order was randomized within each patient. No clear pattern was observed across all patients, either in the TUG test or CoP/CoM inclination angles. Further studies are required to explore the impact that AFO flexibility has on dynamic balance in individuals who have had a stroke.

As órteses de membro superior são dispositivos que auxiliam na reabilitação da mão e que tem como objetivo estabilizar, imobilizar, prevenir e corrigir deformidades, melhorando assim a função. O processo tradicional de confecção de órteses é realizado por meio do uso de termoplásticos de baixa temperatura, material moldado diretamente sobre o membro do usuário, sendo neste processo relatados inúmeros problemas, que envolvem desconforto durante o processo, alto custo e baixa adesão do paciente ao uso. O presente trabalho, portanto, teve por objetivo propor a construção de um framework com abordagem metodológica projetual para a produção de órteses de membro superior baseada no processo de design e design colaborativo, com auxílio de recursos de fabricação digital, como digitalização tridimensional e manufatura aditiva (impressão 3D). Através de uma pesquisa exploratória, foram discutidas questões relativas ao projeto de órteses de membro superior (MMSS) pela forma tradicional, utilizando termoplástico de baixa temperatura, e questões do processo de design no desenvolvimento de novos produtos a serem aplicadas do desenvolvimento de órteses utilizando a manufatura aditiva A coleta de dados contou com a participação dos principais personagens envolvidos no processo, usuários de órteses, Terapeutas Ocupacionais e Designers. Com base na técnica de card sorting e entrevistas, foi elaborado um framework da abordagem projetual para a criação de órteses utilizando processos de fabricação digital, de forma colaborativa. O framework ainda foi aplicado no desenvolvimento de uma órtese a fim de avaliar os resultados e melhorias levantadas durante a fase de entrevistas com profissionais e usuários. Ao final do processo, obteve-se uma órtese funcional em que foram atendidos os requisitos necessários para a produção de uma órtese levantada pelo trabalho, além da criação do framework servindo como um guia para o desenvolvimento de órteses utilizando a manufatura aditiva. / Upper limb orthoses are devices that assist in the rehabilitation of the hand and that aim to stabilize, immobilize, prevent and correct deformities, thus improving the function. The traditional process of making orthotics is accomplished through the use of thermoplastics of low temperature, molded material directly on the member of the user, being in this process reported numerous problems, that involve discomfort during the process, high cost and low adhesion of the patient to the use. The present work, therefore, aimed to propose the construction of a framework with a design methodological approach for the production of upper limb orthosis based on the process of design and collaborative design, with the aid of digital manufacturing resources such as three - dimensional digitization and additive manufacturing (3D printing). Through an exploratory research, questions regarding the design of upper limb orthoses (MMSS) in the traditional way, using low-temperature thermoplastic, and design process issues in the development of new products to be applied in the development of orthoses using the additive manufacture The data collection was attended by the main characters involved in the process, users of orthoses, Occupational Therapists, and Designers. Based on the technique of card sorting and interviews, a framework of the design approach for the creation of orthoses using digital manufacturing processes was developed in a collaborative way. The framework was also applied in the development of a bracing in order to collaborate with the results and improvements raised during the interviews phase with professionals and users. At the end of the process, a functional orthosis was obtained, in which the necessary requirements for the production of an orthosis were obtained by the work, besides the creation of a framework serving as a guide for the development of orthoses using the additive manufacture.

Made available in DSpace on 2014-12-17T14:55:42Z (GMT). No. of bitstreams: 1 MarcioVA_DISSERT.pdf: 2832017 bytes, checksum: fe95d978cb72207522962898bfdc3771 (MD5) Previous issue date: 2010-02-26 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / This work presents the development of a prototype of an intelligent active orthosis for lower limbs whit an electronic embedded system. The proposed orthosis is an orthopedical device with the main objective of providing walking capacity to people with partial or total loss of lower limbs movements. In order to design the kinematics, dynamics and the mechanical characteristics of the prototype, the biomechanics of the human body was analized. The orthosis was projected to reproduce some of the movements of the human gait as walking in straight forward, sit down, get up, arise and go down steps. The joints of the orthosis are controlled by DC motors equipped with mechanical reductions, whose purpose is to reduce rotational speed and increase the torque, thus generating smooth movements. The electronic embedded system is composed of two motor controller boards with two channels that communicate with a embedded PC, position sensors and limit switches. The gait movements of the orthosis will be controlled by high level commands from a human-machine interface. The embedded electronic system interprets the high level commands, generates the angular references for the joints of the orthosis, controls and drives the actuators in order to execute the desired movements of the user / Este trabalho tem como objetivo apresentar o desenvolvimento de um prot?tipo de ?rtese ativa inteligente para membros inferiores com um sistema eletr?nico embarcado. A ?rtese proposta ? um dispositivo ortop?dico com o principal objetivo de proporcionar a capacidade de caminhar para pessoas com parcial ou total perda dos movimentos nos membros inferiores. A fim de determinar a cinem?tica, din?mica e as caracter?sticas mec?nicas do prot?tipo, foi analisada a biomec?nica do corpo humano. A ?rtese foi projetada para reproduzir alguns dos movimentos da marcha humana como andar em linha reta, sentar, levantar, subir e descer degraus. O acionamento das articula??es da ?rtese ? realizado por motores CC equipados com caixa de redu??o, cujo objetivo ? reduzir a velocidade de rota??o e aumentar o torque, gerando assim, movimentos suaveis. O sistema eletr?nico embarcado ? composto por duas placas controladoras de motores com dois canais que se comunicam com um computador embarcado, sensores de posi??o e de fim de curso. O movimento de marcha da ?rtese ? controlado por comandos de alto n?vel fornecidos atrav?s da interface homem-m?quina do sistema. O sistema eletr?nico embarcado ? utilizado para interpretar os comandos de alto n?vel, gerar as refer?ncias angulares para as juntas da ?rtese, acionar e controlar os atuadores da ?rtese de forma a executar os movimentos desejados pelo usu?rio

As órteses de membro superior são dispositivos que auxiliam na reabilitação da mão e que tem como objetivo estabilizar, imobilizar, prevenir e corrigir deformidades, melhorando assim a função. O processo tradicional de confecção de órteses é realizado por meio do uso de termoplásticos de baixa temperatura, material moldado diretamente sobre o membro do usuário, sendo neste processo relatados inúmeros problemas, que envolvem desconforto durante o processo, alto custo e baixa adesão do paciente ao uso. O presente trabalho, portanto, teve por objetivo propor a construção de um framework com abordagem metodológica projetual para a produção de órteses de membro superior baseada no processo de design e design colaborativo, com auxílio de recursos de fabricação digital, como digitalização tridimensional e manufatura aditiva (impressão 3D). Através de uma pesquisa exploratória, foram discutidas questões relativas ao projeto de órteses de membro superior (MMSS) pela forma tradicional, utilizando termoplástico de baixa temperatura, e questões do processo de design no desenvolvimento de novos produtos a serem aplicadas do desenvolvimento de órteses utilizando a manufatura aditiva A coleta de dados contou com a participação dos principais personagens envolvidos no processo, usuários de órteses, Terapeutas Ocupacionais e Designers. Com base na técnica de card sorting e entrevistas, foi elaborado um framework da abordagem projetual para a criação de órteses utilizando processos de fabricação digital, de forma colaborativa. O framework ainda foi aplicado no desenvolvimento de uma órtese a fim de avaliar os resultados e melhorias levantadas durante a fase de entrevistas com profissionais e usuários. Ao final do processo, obteve-se uma órtese funcional em que foram atendidos os requisitos necessários para a produção de uma órtese levantada pelo trabalho, além da criação do framework servindo como um guia para o desenvolvimento de órteses utilizando a manufatura aditiva. / Upper limb orthoses are devices that assist in the rehabilitation of the hand and that aim to stabilize, immobilize, prevent and correct deformities, thus improving the function. The traditional process of making orthotics is accomplished through the use of thermoplastics of low temperature, molded material directly on the member of the user, being in this process reported numerous problems, that involve discomfort during the process, high cost and low adhesion of the patient to the use. The present work, therefore, aimed to propose the construction of a framework with a design methodological approach for the production of upper limb orthosis based on the process of design and collaborative design, with the aid of digital manufacturing resources such as three - dimensional digitization and additive manufacturing (3D printing). Through an exploratory research, questions regarding the design of upper limb orthoses (MMSS) in the traditional way, using low-temperature thermoplastic, and design process issues in the development of new products to be applied in the development of orthoses using the additive manufacture The data collection was attended by the main characters involved in the process, users of orthoses, Occupational Therapists, and Designers. Based on the technique of card sorting and interviews, a framework of the design approach for the creation of orthoses using digital manufacturing processes was developed in a collaborative way. The framework was also applied in the development of a bracing in order to collaborate with the results and improvements raised during the interviews phase with professionals and users. At the end of the process, a functional orthosis was obtained, in which the necessary requirements for the production of an orthosis were obtained by the work, besides the creation of a framework serving as a guide for the development of orthoses using the additive manufacture.