Introduktion: Amputation som åtgärd vid diabeteskomplikationer och vaskulära sjukdomar har använts sedan 1800-talets mitt. Trots framgångsrik forskning kring dessa sjukdomar förutspås amputation relaterat till diabetes och vaskulära sjukdomar öka i västvärlden. Det ingrepp som en amputation innebär påverkar individen både fysiskt och psykiskt och kan leda till förändrad livskvalitet. Syftet: Var att belysa individens livskvalitet efter amputation av nedre extremitet till följd av diabetes och/eller vaskulära sjukdomar. Metod: En litteraturstudie med Polit och Becks (2012) modell som grund. Cinahl och PubMed var de databaser som användes. Resultatet är en sammanställning av två artiklar från Cinahl och tre artiklar från PubMed, samt fem frisöksartiklar. Artiklarna har granskats och bearbetats för att slutligen sammanställts i tre kategorier samt underkategorier. Resultat: Amputation påverkar livskvaliteten rörande den fysiska och mentala funktionen, rollfunktionen och den sociala funktionen. Försämrad fysisk funktion, besvärande känslor och begränsad självständighet är några av de faktorer som har betydelse för den upplevda livskvaliteten. Amputation och synen på den förändrade kroppsbilden är ytterligare faktorer som spelar in, liksom tillgång eller brist på socialt stöd. Slutsats: Amputation är ett kirurgiskt ingrepp som påverkar människans livskvalitet på ett komplext vis då det berör ett flertal faktorer.  Berörda omständigheter interagerar med varandra och kan leda till bland annat minskad fysisk förmåga, nedstämdhet och begränsad självständighet.

The study has investigated some load aspects of the gait of elderly, vascular, lower limb amputees in early stage of rehabilitation, in day to day realistic conditions. The aims were: 1) to understand the gait of recent vascular amputees better, 2) to quantify mechanical loads with two different assistive walking devices. To reach these targets: a removable novel pylon transducer was designed; a fully portable data acquisition system and instrumented canes were used. The new pylon transducer comprised two main parts so that the prosthesis did not need to be altered: 1) an valuminium. bell)) placed within the prosthetic shank tube, having a flange at its base on which the tube of the prosthesis comes to bear; 2) the body of the transducer located inside the bell with an upper contact flange and having clearance to allow the bonding of strain gauges in four levels. A full calibration of the six channels followed by static and dynamic validation tests has been undertaken. They showed a mean accuracy of 7% with a sufficient linearity to be confident in the provided results. Data were recorded through an eight channels 12-bit data acquisition system. At a sampling frequency of 6411z, the recording duration was I hour. Two series of patients have been included in the sample: 30 transtibial and 10 transfemoral amputees. A new pattern for the vertical ground reaction force is described: the second peak was absent, evidently transmitted by the load on the walking devices. The mean load on the walking devices was 35 percent of the body weight. It was also shown that the walking devices not only transmitted axial load but also assisted in the forward acceleration of the body. Three typical gait patterns have been found in the temporal parameters of the gait but none could be discerned for the load distribution.

A high powered 4 DOF prosthesis for transfemoral amputees is presented in this paper. The prosthesis utilizes series elastic actuators with high powered hobby grade helicopter motors capable of providing 2880~W of power each for knee and ankle pitch and ankle roll. In addition, a yaw motor with a planetary gearbox combination is used for yaw actuation providing up to 21~Nm of torque. The prosthesis was designed to accommodate a variety of activities including, but not limited to, walking, running, and stair climbing. / Master of Science / A high powered prosthesis for transfemoral amputees is presented in this paper. Four control mechanisms, three of which are in series with springs to reduce the total power requirement of the motors, are used on the prosthesis to provide power to all motions of the leg. The prosthesis is capable of providing powered motion for knee and ankle pitch, ankle roll, and ankle yaw, i.e. ankle rotation from side to side. The prosthesis was designed to handle a variety of activities including, but not limited to, walking, running, and stair climbing.

Submitted by Fernanda Rodrigues de Lima (fernanda.rlima@ufpe.br) on 2018-07-30T20:08:35Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTAÇÃO Tiago Leitão Bessa Ferreira.pdf: 4519581 bytes, checksum: 7a446c5d10a8f2a779192225e268cc53 (MD5) / Approved for entry into archive by Alice Araujo (alice.caraujo@ufpe.br) on 2018-08-01T22:20:06Z (GMT) No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTAÇÃO Tiago Leitão Bessa Ferreira.pdf: 4519581 bytes, checksum: 7a446c5d10a8f2a779192225e268cc53 (MD5) / Made available in DSpace on 2018-08-01T22:20:06Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTAÇÃO Tiago Leitão Bessa Ferreira.pdf: 4519581 bytes, checksum: 7a446c5d10a8f2a779192225e268cc53 (MD5) Previous issue date: 2017-04-27 / Nos pacientes amputados, o método convencional de fixação da prótese com o membro residual ocorre através da utilização de um encaixe protético, sendo este confeccionado sob medida. Alterações no volume do coto de amputação ocasionam desconforto e dor no uso da prótese e lesões de pele, trazendo ao usuário dificuldade de utilização. Além disso, os pacientes experimentam alterações na marcha e diminuição da amplitude de movimento. O sistema de fixação de prótese diretamente ao osso é uma alternativa para melhorar a qualidade de vida de pacientes amputados, visto que resultam em maior conforto, menor quantidade de lesões, maior controle da prótese e menor alteração da marcha. Com a evolução das técnicas de osseointegração, estudos vêm sendo realizados com o objetivo de aprimorar a tecnologia protética, tanto em termos de compatibilidade com o paciente, como em custo e produção. Este projeto teve como objetivo desenvolver um dispositivo de prótese osseointegrada para pacientes amputados transfemorais. Para tanto, uma análise detalhada dos produtos existentes nos mercados do exterior, seguida de um processo de desenvolvimento de produto, foi realizada a fim de projetar um sistema de próteses osseointegradas para pacientes amputados transfemorais. Este estudo avalia componentes presentes nos sistemas de osseointegração existentes no mercado, e com base em um levantamento de características mecânicas de diversos biomateriais metálicos, elaborou-se um protótipo de adaptador intermediário transcutâneo, adaptador externo e demais componentes adjacentes compostos de CrCoMo. O projeto foi então avaliado através de simulações em software para assegurar que seus requisitos mecânicos mínimos fossem atingidos. A posterior fabricação do protótipo funcional, uma simulação do procedimento cirúrgico em cadáver e um ensaio mecânico foram executados a fim de testar parâmetros como combinações e tamanhos de peças adequados, e técnicas cirúrgicas para a implantação da prótese. Levando-se em conta que este protótipo utiliza tecnologia nacional e os materiais utilizados estão disponíveis no mercado brasileiro, estima-se que o mesmo terá um grande valor tecnológico para o Brasil e um menor custo de produção. Concluímos que o projeto de prótese osseointegrada para amputados transfemorais pode ser produzido com tecnologia nacional. / In amputated patients, the conventional method for fixation of the prosthesis with the residual limb occurs through the use of a prosthetic fitting, which is custom made. Alterations in the volume of the amputation stump cause discomfort and pain in the use of the prosthesis and skin lesions, causing difficulty to the user. In addition, patients experience changes in gait and decreased range of motion. The system for the fixation of the prosthesis directly to the bone is an alternative to improve the quality of life of amputees, since they result in greater comfort, less amount of lesions, greater control of the prosthesis and less alteration of the gait. With the evolution of osseointegration techniques, studies have been carried out with the aim of improving prosthetic technology, both in terms of patient compatibility, cost and production. This project aimed to develop an osseointegrated prosthesis device for transfemoral amputees. In order to do so, a detailed analysis of the existing products in overseas markets, followed by a product development process, was carried out in order to design a system of osseointegrated prosthetics for transfemoral amputees. This study evaluated components present in the osseointegration systems of the market, and based on a survey of the mechanical characteristics of several metallic biomaterials, a transcutaneous intermediate adapter prototype, external adapter and other adjacent components are elaborated. The project was then evaluated through software simulations to ensure that its minimum mechanical requirements have been met. The subsequent fabrication of the functional prototype, a simulation of the surgical procedure in a corpse and a mechanical analysis was performed in order to test parameters such as combinations and sizes of suitable parts, and surgical techniques for prosthetics implantations. Taking into account that this prototype uses national technology and the materials used are available in the Brazilian market, it is estimated that it will have a lower cost of production when inserted in the market and would also help to transfer state-of-the-art technology to Brazil. We conclude that the project of osseointegrated prosthesis for transfemoral amputees can be produced with national technology.

Die vorliegende Arbeit beschäftigt sich mit der altersabhängigen Inzidenz und den Risikofaktoren für das Auftreten von lokalen Gefäßkomplikationen nach Herzkathetern über den femoralen Zugang. Diese sind die häufigsten Komplikationen nach Herzkatheteruntersuchungen überhaupt. Besonders berücksichtigt wurden multimorbide und sehr alte Patienten. Durch den demographischen Wandel und eine stetig wachsende Zahl an durchgeführten Herzkatheterprozeduren wird das Aufkommen solcher Patienten in der Zukunft weiter ansteigen. Der Zugang über die Leistengefäße stellt vielerorts noch immer den meistgenutzten dar. Frühere Studien konnten bereits diverse Risikofaktoren für das Auftreten von lokalen Gefäßkomplikationen nach Herzkathetern ermitteln, unter anderem hohes Alter und typische Alterskrankheiten. In den untersuchten teils sehr kleinen Kohorten wurden oft außerordentlich hohe Komplikationsraten ermittelt. Um zu verhindern, dass alten Patienten aus Sorge um mögliche Komplikationen potentiell lebensrettende invasive Maßnahmen vorenthalten werden, ist eine stetige Risikoevaluation notwendig. In dieser Studie wurden 42.628 Prozeduren bei Patienten, die am Herzzentrum Leipzig zwischen 2005 und 2009 einen diagnostischen Herzkatheter oder eine perkutane Koronarintervention (PCI) erhielten, ausgewertet. Ziel der Arbeit war es, die altersabhängigen Komplikationsraten sowie Prädiktoren für das Auftreten von Komplikationen zu ermitteln. Dazu wurden für drei Altersgruppen (Patienten unter 65, zwischen 65 und 79 sowie über 80 Jahre) jeweils prozedurale und klinische Parameter analysiert. Es wurde ein moderater Anstieg der Komplikationsraten festgestellt. Dies zeigt, dass Herzkatheter über einen Leistenzugang bis ins hohe Alter ein sicheres Verfahren sind. Die ermittelten Prädiktoren können einer klinischen Risikostratifizierung dienen.

Bakgrund Att ha en transfemoral (TF) amputation har en stor inverkan på den amputerades liv med bl.a. större risk för fall, lägre gånghastighet och smärta. I dag är utbudet av kvalitativa studier som visar på hur TF-amputerade upplever sin vardag, mycket begränsat. Det saknas helt studier som tar upp hur det är att ha ett föräldraansvar när man är TF-amputerad.    Syfte Syftet med studien var att se om det fanns några självupplevda problem i vardagen för unilateralt TF-amputerade i föräldrarollen kopplad till deras protes-användning.   Metod Kvalitativa semistrukturerade intervjuer genomfördes med fyra TF-amputerade pappor. Dessa analyserades och tematiserades.    Resultat Vid analysen hittades nio huvudteman: Ansvar, relation med barnen, svårigheter med spontanitet, aktiviteter, miljörelaterade problem, oro, energi och smärta, säkerhet.  Deltagarna upplevade bristande delaktighet, fler konflikter med sina barn och bristande energi.    Slutsats Det finns ett flertal självupplevda problem för TF-amputerade föräldrar och dessa berör främst känslan av delaktighet, relationen med barnen så väl som rent praktiska aspekter. / Background Having a transfemoral (TF) amputation has a major impact on the amputee's life, such as greater risk of falls, lower walking speed and pain. Today, there are no qualitative studies that show how TF-amputees experience their everyday lives and there are no studies that address what it is like to have parental responsibility when you are TF-amputated.   Purpose The aim of this study was to see if there were any self-experienced problems in the everyday life of unilateral TF amputees in the parental role linked to their prosthetic use.   Method Qualitative semi-structured interviews were conducted with four TF-amputated fathers. These were analysed and thematised.   Results Nine main themes were detected during the analysis: Responsibility, relationship with the children, difficulties with spontaneity, activities, environment-related problems, concern, energy and pain and safety. Participants experienced lack of participation, more conflicts with their children and lack of energy.   Conclusion There are self-experienced problems for TF-amputated parents, and these affect the sense of participation, the relationship with the children and practical aspects

Coronary heart disease is a significant cause of mortality and morbidity in the United States; Healthy People 2020 set an objective to reduce the rate of the disease by 20% to the baseline rate of 126 deaths per 100,000 population per year. In the local healthcare setting, heart disease was responsible for a high percentage of mortality and morbidity. To address this, the local site developed a plan to improve outcomes for patients seeking care at the facility. Because the femoral approach to percutaneous coronary intervention (PCI) was used to treat coronary heart conditions at the site and complications were frequent, a quality improvement initiative was begun that included a shift to the use of radial artery PCI. The purpose of this project was to evaluate whether the new approach lowered the complication rates. The project focused question asked how the complication rate of transradial and transfemoral approach to PCI compared. Data from nonrandom aggregate PCI results for 158 adult patients, ages 40-80 years; data from the National Cardiovascular Data Registry; and summarized unit reports were used to compare the transfemoral and transradial outcomes. Two-samples t test results indicated the complications were clinically and significantly lower (p < .01) with patients who underwent the transradial approach (n = 82) compared to those who had the transfemoral approach (n = 76). Study results suggest the new initiative using the transradial approach for PCI reduced the complications for patients undergoing PCI at the site. Positive social change is possible as the morbidity and mortality rates were reduced and consumers who need the procedure may experience a lower burden of physical and fiscal cost.

Testing gait rehabilitation devices on humans can be a difficult task, due to the effects of the neurological controls of the human body. This thesis advances the use of a passive dynamic walker (PDW) tuned to have asymmetric gait patterns similar to those with physical impairments to test rehabilitation devices. A passive dynamic walker is a multipendulum system that has a stable gait pattern when walking down a slope without any energy inputs except the forces due to gravity. A PDW model is better suited for testing rehabilitation devices because it has been shown to resemble human gait and separates the human neurological controls from the purely dynamic aspects of walking. This research uses different asymmetric gait patterns based on an asymmetric PDW to aid in the design of current and future rehabilitation methods. There are four major parts to this research: (1) the derivation of the current nine mass PDW model, (2) the effects of changing the moment of inertia and center of mass on each leg, (3) the effects of having a leg that is longer than the other and adding masses on the opposite leg to generate a symmetric gait, and (4) the design of a theoretical prosthesis that will break the assumption that the knee on the prosthetic leg should be in the same location as the intact leg. The result of changing the moment of inertia and center of mass on each leg in the nine mass model showed that it is an improvement over the previously used five mass model. This is because the five mass model forces the center of mass to change with the moment of inertia, while the nine mass model allows these to be changed independently of each other. A theoretical prosthesis has been developed in this research that is is significantly lighter while maintaining a symmetric gait. This was accomplished by moving the knee of the prosthetic limb below the location of the intact knee.

Background There are more than 300,000 persons in the U.S. living with transfemoral amputation (TFA). Persons with TFA use a knee prosthesis for gait and mobility. Presently, the C-Leg microprocessor knee prosthesis is the standard of care. C-Leg has significantly improved safety and cost efficacy and has created modest gains in gait efficiency. Recently, a new prosthesis has introduced a new sensor array and processor that reportedly improves knee motion, stair function and standing stability. Early claims of the reported functional benefits of the new Genium knee (formerly X2) have not been validated in a rigorous clinical trial. Therefore, the purpose of this project was to determine if the Genium knee improves safety, function and quality of life compared to the current standard of care (C-Leg). Methods The study is a randomized AB crossover with a control group. Subjects must have used (and still be using) a C-Leg for a minimum of 1yr prior to enrollment. Inclusion criteria beyond this are unilateral transfemoral or knee disarticulation amputation for any etiology, community level ambulation (Medicare level 3 or above), independent ambulation and ability to independently provide written, informed consent. Once enrolled subjects utilize their same socket but receive a study foot (Trias or Axtion). Subjects are randomly assigned to either stay with their C-Leg or be fit with a Genium knee. Subjects accommodate and test (A phase) then crossover to the other knee condition and repeat the testing (B phase). A follow up phase of the study beyond the B phase is ongoing to study longer term preference. For AB assessment, three domains were assessed: Safety, function and quality of life. For safety, the PEQ-A survey of stumbles and falls, posturography (Biodex SD limits of stability and postural stability tests), 4 square step test and 2 minute ramp stand test were completed. For function, a series of timed walking tests, the amputee mobility predictor, kinematic gait assessment and physical functional performance-10 tests were conducted. For quality of life, the socioemotional and situational satisfaction domains of the population specific and validated PEQ (prosthesis evaluation questionnaire) were completed. Results Safety: Posturographic assessment revealed impairment between transfemoral amputees and non-amputees. Stumbles and semi-controlled falls decreased with Genium but were not significantly different. Four square step testing was significantly (p 0.05) improved from 12.2s(3.3) to 11.1s(3.4) for the C-Leg and Genium respectively. Function: Kinematic asymmetry was minimally different between knee conditions. The AMP mean(SD) scores while subjects used C-Leg was 40.8(3.6; 33-45) and 43.3(2.6) [p<0.001]. PFP scores (cumulative), upper body function and endurance scores were improved with Genium compared with C-Leg at 9.1%(p=0.03), 8.7%(0.01) and 10.3%(0.04) respectively. Quality of Life: For quality of life, situational satisfaction favored Genium (p<0.001) which included subject's satisfaction with gait, training and quality of life in general. Conclusion C-Leg and Genium promote static weight bearing beyond asymmetric values reported in the literature. In terms of limits of stability, TFA's are clearly impaired, primarily over the amputated side posteriorly however the Genium seems to enable posterior compensations that coincide with multi-directional stepping improvements. Anteriorly, the C-Leg's toe triggering requirements seem to improve limits of stability but come at the cost of discomfort on ramp ascent. With regard to safety, it seems that both knee systems represent good options for the community ambulating TFA. The largest improvements with Genium were in the activities of daily living assessment; predominantly balance and upper body function. It seems that the combination of multi-direction stepping with starts and stops and stair ascent are key areas of improvement. In conclusion, the sensor array in the Genium knee prosthesis promotes improved function in activities of daily living. Specifically improved in this context were balance, endurance, multi-directional stepping, stair ascent and upper limb function in highly active transfemoral amputees.

Following lower-limb amputation, patients suffer from sensory loss within the prosthesis/residuum complex leading to diminished proprioception and balance. Artificial sensory systems have the potential to improve rehabilitation outcomes including better functional usage of lower-limb prostheses to achieve a higher quality of life for the prosthetic users. The purpose of this work was to develop and test the e fficacy of a vibrotactile feedback system for lower-limb amputees that may augment feedback during complex balance and movement tasks. Responses to different vibrotactile stimuli frequencies, locations, and physical conditions were assessed. Key outcome measures for this work were the response time and response accuracy of the subjects to the different stimulator configurations. Frequencies closer to 250 Hz applied to the anterior portion of the thigh resulted in the quickest reaction times. When multitasking, reaction times increased. These preliminary results indicate that vibrotactile sensory feedback may be viable to use by lower-limb amputees.