A caminhada humana é um movimento importante utilizado pelo homem, porém extremamente complexo em relação aos mecanismos energéticos e mecânicos que geram este movimento. O custo energético é maior na caminhada de amputados quando comparada a caminhada de indivíduos sem restrições físicas. Variáveis mecânicas e energéticas de amputados não foram extensivamente estudadas. Nosso objetivo foi avaliar a influência de diferentes velocidades, no recovery, no custo de transporte (C), na eficiência mecânica (Eff), na transdução pendular (Rint), trabalho mecânico, na estabilidade dinâmica, bem como verificar a associação entre a estabilidade dinâmica com recovery, custo de transporte e eficiência mecânica. Participaram do estudo 10 indivíduos amputados transfemurais (com joelho hidráulico e pé em fibra de carbono). Foi realizada cinemetria 3D (quatro câmeras de vídeo) e simultaneamente a análise do consumo de oxigênio. Foram determinadas cinco velocidades de caminhada, após definir a velocidade auto selecionada. Além da velocidade auto selecionada foram definidas duas velocidades acima e abaixo das VAS. Para os dados de Recovery, custo de transporte, eficiência mecânica, transdução pendular, trabalho total, trabalho externo, travalho vertical, trabalho horizontal, trabalho interno e estabilidade dinâmica foram utilizadas rotinas desenvolvidas em Matlab®. A velocidade influencia nos parâmetros mecânicos e energéticos da caminhada de amputados transfemurais. Os maiores valores para: economia de caminhada, Recovery, transdução pendular, eficiência mecânica, trabalho mecânico interno e vertical, e estabilidade dinâmica foram obtidos na máxima velocidade de caminhada dos sujeitos. As correlações entre o coeficiente de variação do comprimento da passada e Recovery, custo de transporte e potência metabólica foram moderadas. Esses resultados são de grande relevância para a área clínica e ponderados durante o processo de reabilitação desses indivíduos. / The human walking is an important movement used by man, but extremely complex in relation to the energetic and mechanical mechanisms that generate this movement. The energy cost of gait is greater in amputees than in normal subjects. Mechanical and energetics variables in amputees have not been extensively studied. Our objective was to assess the influence of speed in recovery, cost of transport (C), mechanical efficiency (Eff), pendular transduction (Rint), mechanic parameters, dynamical stability, well as to verify agreement between dynamical stability with recovery, C, Eff and metabolic power. Materials and Methods: ten transfemoral amputees (with hydraulic knee and carbon fiber foot) were selected in the study. Simultaneously three-dimensional (3D) kinematics data (four cameras) and oxygen consumption were collected at five speeds, two above and two below self-select one. The Recovery, C, Eff, Rint, dynamical stability, were processed using Matlab software. Mechanics and energetics of amputee walking were influenced by speed. In maximal speed of amputee walking were reported greatest values, like: recovery, cost of transport (C), mechanical efficiency (Eff), pendular transduction (Rint), internal and vertical mechanical work and dynamical stability. Pearson correlation between dynamical stability and Recovery, C, Eff and metabolic power were moderate. These results are clinical relevance and should be considered during the rehabilitation of these individuals.

A caminhada humana é um movimento importante utilizado pelo homem, porém extremamente complexo em relação aos mecanismos energéticos e mecânicos que geram este movimento. O custo energético é maior na caminhada de amputados quando comparada a caminhada de indivíduos sem restrições físicas. Variáveis mecânicas e energéticas de amputados não foram extensivamente estudadas. Nosso objetivo foi avaliar a influência de diferentes velocidades, no recovery, no custo de transporte (C), na eficiência mecânica (Eff), na transdução pendular (Rint), trabalho mecânico, na estabilidade dinâmica, bem como verificar a associação entre a estabilidade dinâmica com recovery, custo de transporte e eficiência mecânica. Participaram do estudo 10 indivíduos amputados transfemurais (com joelho hidráulico e pé em fibra de carbono). Foi realizada cinemetria 3D (quatro câmeras de vídeo) e simultaneamente a análise do consumo de oxigênio. Foram determinadas cinco velocidades de caminhada, após definir a velocidade auto selecionada. Além da velocidade auto selecionada foram definidas duas velocidades acima e abaixo das VAS. Para os dados de Recovery, custo de transporte, eficiência mecânica, transdução pendular, trabalho total, trabalho externo, travalho vertical, trabalho horizontal, trabalho interno e estabilidade dinâmica foram utilizadas rotinas desenvolvidas em Matlab®. A velocidade influencia nos parâmetros mecânicos e energéticos da caminhada de amputados transfemurais. Os maiores valores para: economia de caminhada, Recovery, transdução pendular, eficiência mecânica, trabalho mecânico interno e vertical, e estabilidade dinâmica foram obtidos na máxima velocidade de caminhada dos sujeitos. As correlações entre o coeficiente de variação do comprimento da passada e Recovery, custo de transporte e potência metabólica foram moderadas. Esses resultados são de grande relevância para a área clínica e ponderados durante o processo de reabilitação desses indivíduos. / The human walking is an important movement used by man, but extremely complex in relation to the energetic and mechanical mechanisms that generate this movement. The energy cost of gait is greater in amputees than in normal subjects. Mechanical and energetics variables in amputees have not been extensively studied. Our objective was to assess the influence of speed in recovery, cost of transport (C), mechanical efficiency (Eff), pendular transduction (Rint), mechanic parameters, dynamical stability, well as to verify agreement between dynamical stability with recovery, C, Eff and metabolic power. Materials and Methods: ten transfemoral amputees (with hydraulic knee and carbon fiber foot) were selected in the study. Simultaneously three-dimensional (3D) kinematics data (four cameras) and oxygen consumption were collected at five speeds, two above and two below self-select one. The Recovery, C, Eff, Rint, dynamical stability, were processed using Matlab software. Mechanics and energetics of amputee walking were influenced by speed. In maximal speed of amputee walking were reported greatest values, like: recovery, cost of transport (C), mechanical efficiency (Eff), pendular transduction (Rint), internal and vertical mechanical work and dynamical stability. Pearson correlation between dynamical stability and Recovery, C, Eff and metabolic power were moderate. These results are clinical relevance and should be considered during the rehabilitation of these individuals.

Syfte: Syftet med det här examenarbete är att undersöka behovet av snabbkopplingsadaptrar för protesbrukare.   Bakgrund: Snabbkopplingsadapter är en förhållandevis ny produkt som både Otto Bock och Lindhe Xtend erbjuder, men ingen forskning på behovsområdet finns ännu gjord. Fördelen med produkten är enligt leverantörernas hemsidor bl a att man med den enkelt kan byta mellan olika proteskomponenter utan att behöva skruva på några protesinställningar eller byta hylsa.   Metod: För att undersöka behovet av snabbkopplingsadaptrar utfördes semistrukturella intervjuer av fenomenologisk karaktär. En serie med sju frågor sammanställdes som intervjuunderlag, vilka togs fram utifrån de tre behovsfokusområdena: Funktion, delaktighet och livskvalité. I undersökningen ingick n=6 deltagare, varav n=3 transtibialt amputerade och n=3 transfemoralt amputerade. Insamlade data analyserades vidare för framtagning av olika teman och resultat.   Resultat: Utifrån intervjuunderlaget togs följande teman fram: Byte av protesfötter/protesknäleder, På- och avtagning av byxor, Hylspassform, Transport samt Biomekanik. Varje tema utgjorde ett eget potentiellt användningsområde, där de största behoven visade sig ligga inom temana Byte av protesfötter/protesknäleder, Hylspassform samt Transport.   Slutsats: Behovet av snabbkopplingsadaptrar är högst subjektivt, och beror snarare på deltagarens liv än några allmänna faktorer. Däremot upptäcktes ett antal tänkbara användningsområden för den. / Aim: The aim of this thesis was to investigate the necessity of the quick change adapter for lower limb amputees.   Background: Quick Change Adapter is a relatively new product that both Otto Bock and Lindhe Xtend offers, but no research has been done on the area of its necessity yet.  According to the supplier´s websites the benefits of the product is that you with it easily can change prosthetic components without affecting the alignments or change socket.   Method: To investigate the necessity of the Quick Change Adapter, semi structural interviews of phenomenological characteristic were used.  A series of seven questions were compiled as a basis for the interview from the three focus areas: Function, participation and quality of Life. The thesis involved n=6 participants, of who n=3 was trantibial amputated and n=3 transfemoral amputated. Collected data was later analysed to find general themes and results.   Results: From the interviews these themes were exposed: Changing prosthetic feet/prosthetic knee joints, Donn and doff of pants, Socket fit, Transport and Biomechanics. Each theme presented a potential application area where the biggest needs seemed to be in Changing prosthetic feet/prosthetic knee joints, Socket fit and Transport.   Conclusions: The necessity of the Quick Change Adapter turned out to be very subjective, and depended more on the participant´s life then any general factors. Still there were some potential application areas detected for it.

Objective: Studies have shown that iodinated radiocontrast use is associated with acute renal failure especially in the presence of chronic kidney disease and multiple factors modulate this risk. The purpose of this meta-analysis is to compare the incidence of renal failure requiring hemodialysis between transfemoral (TF) and transapical (TA) transcatheter aortic valve replacement using the Edwards valve. Methods: The PubMed database was searched from January 2000 through December 2014. A total of 10 studies (n = 2,459) comparing TF (n = 1,268) and TA (n = 1,191) TAVR procedures using the Edwards valve were included. Variables of interest were baseline logistic EuroSCORE, prevalence of diabetes mellitus, hypertension, peripheral arterial disease, chronic kidney disease and amount of contrast used. The primary endpoint was incidence of renal failure requiring hemodialysis. The odds ratio and 95% CI were computed and P < 0.05 was considered as the level of significance. Results: The logistic EuroSCORE was significantly higher in TA compared to TF (P = 0.001) TAVR. The amount of contrast (mL) used was significantly higher in the TF group compared to the TA group (mean difference: 36.9, CI: 25.7-48.1, P < 0.001). The incidence of hemodialysis following the procedure was significantly higher in the TA group compared to TF group (odds ratio = 4.3, CI: 2.4-7.8, P < 0.00001). Conclusions: This meta-analysis suggests that despite the lower amount of contrast used in TA-TAVR, the incidence of renal failure requiring hemodialysis was higher with the Edwards valve. This suggests that the incidence of renal failure requiring hemodialysis after TAVR is associated with baseline comorbidities in the TA-TAVR group rather than the volume of contrast used.

The purpose of this literature review was to identify any adaptations that could be made to the rehabilitation process for Traumatic Transfemoral Amputees. Traumatic Transfemoral Amputation is particularly debilitating with the amputees encountering many obstacles throughout the rehabilitation process. These obstacles can prevent the return to pre-morbid functioning. With an ever-increasing number of amputees within the United States, it is imperative the rehabilitation process be addressed. This literature review addresses possible adjustments in the initial stages of rehabilitation examining the post-operative, pre-prosthetic, and prosthetic rehabilitation stage to enhance the physical functioning for the amputee. This comprehensive literature review encompassing 63 academic and medical journals analyzes the research literature regarding each of the three stages of the post-operative procedure. The literature review synthesizes the research findings to see how procedures may be adapted to reduce the risk of further co-morbidities such as loss of bone mineral density and disuse atrophy. Loss of bone mineral density and disuse atrophy are the major contributing factors to the amputees decreased mobility. Reducing this loss can be addressed within the initial post-operative, pre-prosthetic, and prosthetic rehabilitation stages. Further research is required to examine the efficacy of these alterations in relation to this specific population.

Several studies have been devoted to the metabolic costs of amputees walking on prostheses with different masses added to their components. However, limited study has been directed at quantifying the mass differences of the actual materials available to amputees and the metabolic and mechanical work required to walk on these materials. The energetics of two materials currently used in the design of lower extremity prosthetics were examined in an attempt to determine if mass differences had an effect on amputee walking. A total of fifteen, unilateral amputees (8 transfemoral and 7 transtibial) performed treadmill walking on prostheses assembled from titanium and stainless steel components. Standardized components (knees, pylons, adapters, feet) made from each material were added below the level of the socket. Submaximal oxygen consumption {W/kg} and mechanical power allowing transfers within and between segments {W/kg} were calculated as subjects walked at self-selected velocities until steady state was achieved. Results show that despite significant mechanical differences [F(1,12)= 4.85, p<.048], the decreased mass associated with the use of titanium materials does not have an effect on the metabolic costs [F(1,14)=1.45, p<.249] of the subjects in this study. In addition, stride rate and stride length showed little differences when walking with both materials. Further division of subjects by age and experience walking on a prosthesis do suggest that older amputees and established walkers do benefit most from the use of titanium, both metabolically and mechanically. The choice of materials for use in every day walking will display differences in the mechanical work of amputees however, these differences are not great enough to realize metabolic consequences. / Thesis / Master of Science (MS)

Yes / Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. Methods: Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its ‘ramp-descent’ mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. Findings: Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). Interpretation: Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity. / ZA is funded by the Higher Committee of Education Development in IRAQ (HCED student number D13 626).

Introduction: Transcatheter aortic valve implantation (TAVI) is an established procedure to treat severe aortic stenosis (AS). This study investigates the impact of ischemic heart disease (IHD) on survival in patients undergoing TAVI. Aim: Five-year all-cause mortality stratified according to the presence or absence of IHD. Methods: Retrospective register study including all patients that underwent a TAVI-procedure 2009 to 2018. Patients were stratified according to the presence or absence of IHD. Our primary end-point was five-year all-cause mortality. Survival was analyzed using Kaplan-Meier curve. Data were acquired through the SWENTRY registry and patient files. Results: A total of 264 patients were included in the study, with 139 (52.7 %) patients in the IHD group vs 125 (47.3 %) patients in the non-IHD group. Mean follow-up time was 40 ±30 months. At baseline, there was a higher proportion of males, patients with hypertension, peripheral arterial disease, left ventricular ejection fraction &lt;50 % and, a higher EuroSCORE I in the IHD-group. Transfemoral approach was most common in both groups. No differences were noted in respect to peri- and postoperative complications. Five-year all-cause mortality was 17/38 (44.7 %) vs 18/30 (60.0 %), p = 0,232, in the IHD and non-IHD group respectively. Non-adjusted cumulative five-year survival was not significantly different between the groups (Log-Rank, p = 0,056). Conclusions: In patients with severe AS undergoing TAVI, the five-year all-cause mortality was not statistically different between patients with or without IHD.

Tyrimo objektas: fantominio skausmo ir raumenų jėgos pokytis po kineziterapijos ir grįžtamojo ryšio. Tyrimo tikslas: įvertini kineziterapijos ir grįžtamojo ryšio poveikį fantominiams skausmams ir šlaunies raumenų jėgai po šlaunies amputacijos. Hipotezė: manome, kad taikant kineziterapiją ir grįžtamąjį ryšį po šlaunies amputacijos, fantominių skausmų intensyvumas sumažės ir šlaunies raumenų jėga padidės labiau, nei taikant kineziterapiją be grįžtamojo ryšio. Uždaviniai: 1. Palyginti fantominių skausmų intensyvumą ir šlaunies raumenų jėgą po šlaunies amputacijos kineziterapijos pradžioje ir po įprastinės be grįžtamojo ryšio kineziterapijos. 2. Palyginti fantominių skausmų intensyvumą ir šlaunies raumenų jėgą po šlaunies amputacijos kineziterapijos pradžioje ir po kineziterapijos kartu su grįžtamuoju ryšiu. 3. Palyginti įprastinės kineziterapijos ir kineziterapijos kartu su grįžtamuoju ryšiu poveikį fantominių skausmų intensyvumui ir šlaunies raumenų jėgai. Rezultatai: Tyrimo pradžioje, kontrolinės grupės tiriamieji fantominį skausmą įvertino 6,17±0,75, tiriamosios grupės tiriamieji – 6,83±0,75 balais. Tyrimo pabaigoje, kontrolinė grupė – 5,86±0,75, tiriamoji grupė – 5,17±0,75 balais. Prieš kineziterapiją kontrolinėje grupėje, po amputacijos, šlaunį tiesiančių raumenų jėga buvo 3,00±0,00, lenkiančių – 3,33±0,52, pritraukiančių – 2,83±0,51 ir atitraukiančių – 2,50±0,55 balų; tiriamojoje grupėje, šlaunį lenkiančių raumenų jėga buvo 3,17±0,47, tiesiančių – 3,00±0,00... [toliau žr. visą tekstą] / The object: effects of physiotherapy with mirror therapy for phantom pain and thigh muscle strength after transfemoral. The objective: the alteration of phant pain and thigh muscle after physiotherapy and mirror therapy. Hyptohesis: We consider, that the application of physiotherapy with mirror therapy helps to reduce phantom pain and improve muscle strenght better than physiotherapy without mirror therapy. The aims: 1. To compare phantom pain and muscle force in the beginning of physiotherapy and after physiothepy. 2. To compare phantom pain and muscle force in the beginning of physiotherapy and after physiotherapy with mirrot therapy. 3. To compare physiotherapy with mirror therapy and physiotherapy without mirror therpy for phantom pain and muscle force. Results: Beginning of the study, the control group subjects phantom pain score 6.17 ± 0.75, experimental group subjects - 6.83 ± 0.75 points. End of the study, the control group - 5.86 ± 0.75, experimental group - 5.17 ± 0.75 points. Before physical therapy in the control group after the amputation, the thigh muscle stretching force was 3.00 ± 0.00, flexion - 3.33 ± 0.52, attracting - 2.83 ± 0.51 and distracting - 2.50 ± 0.55 scores, the experimental group, the thigh, the muscle strength was 3.17 ± 0.47, stretching - 3.00±0.00, attracting - 2.67±0.47 and distracting-2.83±0.37 points. Application of physical therapy procedures, after 3 weeks, the control group, after the amputation, the thigh flexion strength was 4.33 ± 0... [to full text]

Transfemoral amputees around the world experience increased difficulty in climbing stairs due to lack of muscle, balance, and other factors. The loss of a lower limb greatly diminishes the amount of natural force generation provided that is necessary to propel oneself up stairs. This study investigated possible solutions to the problem of stair ascension for transfemoral amputees by the means of designing and developing an externally attachable device to a prosthesis. The number of amputations from military service has greatly increased since 2008, which shows there is a clear need for assistive devices (Wenke, Krueger, & Ficke, 2012). With the number of amputations rising and no current externally attachable products on the market to aid in stair ascension for transfemoral amputees, the need for this specific device has become more prominent. Research, previous work, and preliminary testing provided a basis for design and development of a new prototype. Bench top testing was conducted to review concepts in the prototype and provide data for further modifications. Results from testing of previous work, as well as testing of new concepts and modifications, provided a framework for designing a new externally attachable device for assistance in stair ascension. A new prototype was then designed, manufactured, and tested with bench models as well as real-time testing with amputees. Success of the device’s performance was based on bench top results and feedback from amputees, noting both the advantages and shortcomings of the new prototype. Testing provided results and feedback that the device was well built and functioned properly, but did not perform satisfactorily, particularly in the categories of force generation and balance.