Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Diss. Luleå : Luleå tekniska universitet, 2007. / Härtill 4 uppsatser.

Made available in DSpace on 2014-12-17T14:53:23Z (GMT). No. of bitstreams: 1 AlessandraCAS.pdf: 478300 bytes, checksum: be5bf7503cba8da555b4037506a0c710 (MD5) Previous issue date: 2006-05-19 / The purpose of this paper is to identify the utilization of two models of orthotics used in the conservative treatment of rizartrose in patients/consumers that were referred by the medical clinic to the LAI (Laboratory of Integrated Accessibility). It describes this group s perception related to the functional aspects of the two models, evaluates the value of the product attributed by the patient/consumer and describes the importance attributed to each model. The research s objective consists in identifying which model this is preferred from the point of view by the patients that use either the dorsal or ventral models used in the conservative treatment of rizartrose . This work is then based on the exploratory research through the investigation of the bibliography available and in the research field. The research field used the case study methodology to investigate the phenomenon in the real context. The data were collected using a patient questionnaire during two times after the use of the dorsal orthotic and after the use of the ventral orthotic. The questionnaire was used to identify the relationship between the patients/consumers and the two different types of orthotics. A general descriptive analysis was used in order to verify the patient s abilities executing certain activities daily living using the dorsal and ventral orthotics, the product s functional aspects and its value from the patient s/consumer s point of view. The results show that the preference for the dorsal or ventral models is determined by the individual needs of each person. The results also show that other variables, such as the use of the orthotic on the dominant or non-dominant hand, play a role in the preferred model by the patient/consumer and need to be further investigated / Esta pesquisa tem como proposta investigar a utiliza??o de dois modelos de dispositivo ort?tico usados no tratamento conservador da rizartrose de pacientes/consumidores que foram encaminhados ao LAI (Laborat?rio de Acessibilidade Integrada) pela cl?nica m?dica. Ainda, descreve as percep??es deste grupo sobre os aspectos funcionais dos dois modelos do dispositivo, avalia o valor do produto atribu?do pelo paciente/consumidor e descreve a import?ncia conferida a cada modelo. O objetivo desta pesquisa consiste em identificar entre os modelos de ?rtese dorsal e ventral, utilizados no tratamento conservador da rizartrose, aquele que ? preferido para uso sob a ?tica do pr?prio paciente/consumidor. Desta forma, o trabalho tem sua forma??o baseada na pesquisa do tipo explorat?ria atrav?s de investiga??o em fontes bibliogr?ficas e em pesquisa de campo. Na pesquisa de campo foi adotado como procedimento metodol?gico o estudo de caso, por se propor a investigar o fen?meno em seu contexto real. Os dados foram coletados com a aplica??o de formul?rio junto aos pacientes/consumidores em dois momentos-ap?s uso de ?rtese dorsal e ap?s uso de ?rtese ventral. O formul?rio busca identificar a rela??o de cada paciente/consumidor com os dois modelos do dispositivo. Atrav?s de uma an?lise descritiva geral foi verificado sobre a habilidade do paciente na execu??o de determinadas tarefas cotidianas em uso de ?rtese dorsal e ventral, sendo seguido da apresenta??o dos aspectos funcionais dos produtos e do valor sob a ?tica do paciente/consumidor. Os resultados mostram que a prefer?ncia para uso do modelo dorsal ou ventral ? determinada pelas necessidades individuais de cada pessoa. Os resultados mostram tamb?m a exist?ncia de outros pressupostos que exercem influencia na escolha do modelo pelo paciente/consumidor, como o uso de ?rtese na m?o contralateral a dominante

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Yes / Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. Methods: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. Results: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. Conclusions: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings. / The SCRIPT (Supervised Care & Rehabilitation Involving Personal Telerobotics) project was partly funded by the European Commission Seventh Framework Program under grant agreement no. FP7-ICT-288698.

Our research is focused on using orthotic devices in patients with Duchenne muscular dystrophy (DMD), particularly in the ambulant phase of the disease. DMD is the most common hereditary muscle disorder in childhood. The typical symptoms are progressive muscle weakness and contractures that lead to loss of ability of independent walking, typically among the age of 9 to 13 years. The theoretical part is focused on pattern of standing and walking in these patients, the posibilities of useing the orthotic devices in various stages of the disease, and on the problems of contractures and deformities. The other teoretical part of the work is devoted to certain physiotherapy interventions and to associated physical activities. The practical part of the research is based on assesment of effect of physiotherapy and use of the nigt orthesis AFO (Ankle- Foot-Orthesis) in group of 10 DMD boys in the average age 9,1 ± 2,7 years. All boys were examined before and after 6 month of therapy. In examinations the following tests were used: NSAA (North Star Ambulatory Assessment), BI (Barthel index) measurements of muscle strength by hand held myometr and measurement of PROM (passive range of motion). The practical part also includes analysis of questionnaire datas from 19 patients with DMD collected in year 3/2013, questions...

Objetivo: Avaliar a eficácia da palmilha em cunha medial na osteoartrite (OA) com joelho valgo. Método: 30 mulheres com OA de joelhos e deformidade em valgo > 8 graus, foram randomizados em 2 grupos: o experimental, que utilizou palmilha com elevação medial no retropé de 8 mm (n = 16) e o controle que usou uma palmilha similar, sem elevação (n = 14), e em ambos associou-se um estabilizador de tornozelo. Um examinador cego avaliou dor noturna, ao movimento e ao repouso (Escala Visual Analógica), índice de Lequesne e questionário WOMAC, e os ângulos femurotibial, talocalcâneo e de inclinação do talus, no início e após 8 semanas de uso das palmilhas. Resultados: No grupo experimental, houve redução da dor ao repouso (5,06 + 2,29 vs 2,73 + 2,40, p = 0,002), ao movimento (8,13 + 1,50 vs 4,20 + 2,36, p = 0,001), e noturna (6,06 + 2,74 vs 3,13 + 2,07, p = 0,001), Lequesne (14,75 + 3,36 vs 9,60 + 3,83, p = 0,001 ) e WOMAC (74,13 + 14,20 vs 56,13 + 14,94, p = 0,001). No grupo controle, houve apenas uma leve redução da dor noturna (5,79 + 2,39 vs 4,64 + 2,38, p = 0,019). Houve um aumento do ângulo femurotibial no grupo experimental (169,05 +3,43 vs 170,81 + 3,73, p = 0,001). Os demais ângulos permaneceram inalterados em ambos os grupos. Conclusão: O uso de palmilha em cunha medial foi eficaz no controle da osteoartrite do joelho valgo. / Objective: To assess the efficacy of medial-wedge insole in valgus knee osteoarthritis (OA). Method: 30 females with valgus deformity knee OA > 8 degrees were randomized into 2 groups: an experimental group, which used insoles with medial elevation at the hindfoot of 8 mm (n = 16), and a control group which used a similar insole without elevation (n = 14), where both groups also wore ankle supports. A blinded examiner assessed pain on movement, at rest and at night (Visual Analog Scale), the Lequesne index and WOMAC questionnaire, along with femorotibial, talocalcaneal and talar tilt angles, at baseline and following 8 weeks? insole use. Results: Reductions were observed in the experimental group for pain at rest (5.06 + 2.29 vs 2.73 + 2.40, p = 0.002), on movement (8.13 + 1.50 vs 4.20 + 2.36, p = 0.001), at night (6.06 + 2.74 vs 3.13 + 2.07, p = 0.001), and in Lequesne (14.75 + 3.36 vs 9.60 + 3.83, p = 0.001 ) and WOMAC scores (74.13 + 14.20 vs 56.13 + 14.94, p = 0.001). For the control group, only a slight reduction in night pain was seen (5.79 + 2.39 vs 4.64 + 2.38, p = 0.019). There was an increase in the femorotibial angle in the experimental group (169.05 +3.43 vs 170.81 + 3.73, p = 0.001). The other angles remained unchanged in both groups. Conclusion: The use of medial-wedge insoles proved effective in controlling symptoms of valgus knee osteoarthritis

Objetivo: Avaliar a eficácia da palmilha em cunha medial na osteoartrite (OA) com joelho valgo. Método: 30 mulheres com OA de joelhos e deformidade em valgo > 8 graus, foram randomizados em 2 grupos: o experimental, que utilizou palmilha com elevação medial no retropé de 8 mm (n = 16) e o controle que usou uma palmilha similar, sem elevação (n = 14), e em ambos associou-se um estabilizador de tornozelo. Um examinador cego avaliou dor noturna, ao movimento e ao repouso (Escala Visual Analógica), índice de Lequesne e questionário WOMAC, e os ângulos femurotibial, talocalcâneo e de inclinação do talus, no início e após 8 semanas de uso das palmilhas. Resultados: No grupo experimental, houve redução da dor ao repouso (5,06 + 2,29 vs 2,73 + 2,40, p = 0,002), ao movimento (8,13 + 1,50 vs 4,20 + 2,36, p = 0,001), e noturna (6,06 + 2,74 vs 3,13 + 2,07, p = 0,001), Lequesne (14,75 + 3,36 vs 9,60 + 3,83, p = 0,001 ) e WOMAC (74,13 + 14,20 vs 56,13 + 14,94, p = 0,001). No grupo controle, houve apenas uma leve redução da dor noturna (5,79 + 2,39 vs 4,64 + 2,38, p = 0,019). Houve um aumento do ângulo femurotibial no grupo experimental (169,05 +3,43 vs 170,81 + 3,73, p = 0,001). Os demais ângulos permaneceram inalterados em ambos os grupos. Conclusão: O uso de palmilha em cunha medial foi eficaz no controle da osteoartrite do joelho valgo. / Objective: To assess the efficacy of medial-wedge insole in valgus knee osteoarthritis (OA). Method: 30 females with valgus deformity knee OA > 8 degrees were randomized into 2 groups: an experimental group, which used insoles with medial elevation at the hindfoot of 8 mm (n = 16), and a control group which used a similar insole without elevation (n = 14), where both groups also wore ankle supports. A blinded examiner assessed pain on movement, at rest and at night (Visual Analog Scale), the Lequesne index and WOMAC questionnaire, along with femorotibial, talocalcaneal and talar tilt angles, at baseline and following 8 weeks? insole use. Results: Reductions were observed in the experimental group for pain at rest (5.06 + 2.29 vs 2.73 + 2.40, p = 0.002), on movement (8.13 + 1.50 vs 4.20 + 2.36, p = 0.001), at night (6.06 + 2.74 vs 3.13 + 2.07, p = 0.001), and in Lequesne (14.75 + 3.36 vs 9.60 + 3.83, p = 0.001 ) and WOMAC scores (74.13 + 14.20 vs 56.13 + 14.94, p = 0.001). For the control group, only a slight reduction in night pain was seen (5.79 + 2.39 vs 4.64 + 2.38, p = 0.019). There was an increase in the femorotibial angle in the experimental group (169.05 +3.43 vs 170.81 + 3.73, p = 0.001). The other angles remained unchanged in both groups. Conclusion: The use of medial-wedge insoles proved effective in controlling symptoms of valgus knee osteoarthritis

Componentes de próteses e órteses humanas devem ser confortáveis, capazes de realizar as funções esperadas e, mais do que tudo, confiáveis. O foco deste trabalho é no desenvolvimento e aplicação de uma metodologia de análise de parafusos cirúrgicos. Para tanto foi desenvolvido um aparato mecânico, que consiste em um atuador de torque e um sistema de aquisição de dados. O atuador, composto por um motor elétrico acoplado a um redutor, aplica torque sobre o parafuso em teste, que o transfere a uma célula de carga e, assim, ao sistema de aquisição de dados. Parafusos canulados de aço inoxidável e corticais de titânio, de diferentes fabricantes, foram testados para torque de inserção e remoção, torque máximo e ângulo de ruptura. Os resultados mostraram que, apesar de todos os parafusos canulados seguirem os padrões recomendados, foram encontradas dispersões significativas entre os resultados verificados para os parafusos corticais de titânio, o que indica problemas de material ou manufatura. Os resultados mostraram valores mais elevados para torque de remoção que de inserção, o que, apesar de esperado, não é um efeito desejável, uma vez que facilita a fratura após a convalescência do paciente, em uma eventual remoção do parafuso. A análise dos resultados mostra a eficiência da metodologia desenvolvida, e chama a atenção para a confiabilidade dos componentes de órteses e próteses. / Human orthotic device components must be comfortable, able to execute the expected functions and, most of everything reliable. The focus of this work is the development and application of a surgical screw resistance analysis methodology. For this, a mechanical apparatus, consisting of a torque actuator and a data acquisition system was developed. The actuator, composed by an electric engine and reducer, applied torque on the tested screw, who transfers it to a load cell, especially developed, and thus to the data acquisition system. Cortical titanium and cannulated stainless steel bone screws were tested, from different manufacturers, for insertion and removal torque, maximum torque and rupture angle. The results showed that, despite that all cannulated screws had followed the recommended standards, it was found significant dispersion among the results for titanium cortical screws, which indicates manufacturing or material defects. Results also showed that removal torque was always higher than insertion torque. This is an undesirable, yet expected, effect, once fractures may come to happen after the healing of the patient, or even on the occasion of a substitution. The analysis showed the efficiency of the methodology developed, and opens a point of discussion on orthotic reliability.

Componentes de próteses e órteses humanas devem ser confortáveis, capazes de realizar as funções esperadas e, mais do que tudo, confiáveis. O foco deste trabalho é no desenvolvimento e aplicação de uma metodologia de análise de parafusos cirúrgicos. Para tanto foi desenvolvido um aparato mecânico, que consiste em um atuador de torque e um sistema de aquisição de dados. O atuador, composto por um motor elétrico acoplado a um redutor, aplica torque sobre o parafuso em teste, que o transfere a uma célula de carga e, assim, ao sistema de aquisição de dados. Parafusos canulados de aço inoxidável e corticais de titânio, de diferentes fabricantes, foram testados para torque de inserção e remoção, torque máximo e ângulo de ruptura. Os resultados mostraram que, apesar de todos os parafusos canulados seguirem os padrões recomendados, foram encontradas dispersões significativas entre os resultados verificados para os parafusos corticais de titânio, o que indica problemas de material ou manufatura. Os resultados mostraram valores mais elevados para torque de remoção que de inserção, o que, apesar de esperado, não é um efeito desejável, uma vez que facilita a fratura após a convalescência do paciente, em uma eventual remoção do parafuso. A análise dos resultados mostra a eficiência da metodologia desenvolvida, e chama a atenção para a confiabilidade dos componentes de órteses e próteses. / Human orthotic device components must be comfortable, able to execute the expected functions and, most of everything reliable. The focus of this work is the development and application of a surgical screw resistance analysis methodology. For this, a mechanical apparatus, consisting of a torque actuator and a data acquisition system was developed. The actuator, composed by an electric engine and reducer, applied torque on the tested screw, who transfers it to a load cell, especially developed, and thus to the data acquisition system. Cortical titanium and cannulated stainless steel bone screws were tested, from different manufacturers, for insertion and removal torque, maximum torque and rupture angle. The results showed that, despite that all cannulated screws had followed the recommended standards, it was found significant dispersion among the results for titanium cortical screws, which indicates manufacturing or material defects. Results also showed that removal torque was always higher than insertion torque. This is an undesirable, yet expected, effect, once fractures may come to happen after the healing of the patient, or even on the occasion of a substitution. The analysis showed the efficiency of the methodology developed, and opens a point of discussion on orthotic reliability.