Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

INTRODUÇÃO: A escala MESS foi um instrumento desenvolvido para auxiliar o cirurgião na decisão entre amputar e preservar o membro inferior gravemente lesado. Neste estudo acompanhamos um grupo de pacientes com fratura exposta dos ossos da perna com MESS >= sete, preditivo para amputação, durante seu tratamento até a sua reabilitação completa. OBJETIVO: O objetivo do estudo foi determinar a relação de sucesso/insucesso funcional nos pacientes com escore MESS >= sete com o membro reconstruído no longo prazo (mínimo de dez anos de seguimento). MÉTODOS: Foram incluídos no estudo, os pacientes com fratura exposta Gustilo IIIB e IIIC dos ossos da perna com critérios de membros inferiores gravemente lesados modificados de Gregory e Bonanni e escore MESS >= sete. Os pacientes foram incluídos no período de 2003-2006. Os pacientes foram avaliados através da Medida de Independência Funcional e escala de incapacidade pela dor. RESULTADOS: Dos 26 pacientes selecionados, foram realizadas amputações em cinco e preservação do membro acometido, após intervenções, em 21 pacientes. Nove pacientes foram reavaliados após mais de 10 anos de seguimento. Destes, sete apresentavam o membro preservado e apenas um teve a reconstrução considerada como falha. Dos pacientes preservados, o paciente com fratura exposta Gustilo IIIC teve a reconstrução considerada falha. As duas amputações também foram consideradas funcionais. CONCLUSÃO: A escala MESS não é um bom instrumento para indicar amputação / INTRODUCTION: The MESS score was designed as a tool to assist the surgeon in deciding between amputate or preserve the severely injured lower limb. In this study we followed patients with severe open fractures of the leg with MESS >= seven, predictive for amputation during their treatment until their complete rehabilitation. OBJETIVE: The aim of the study was to determine the relative success / failure in patients with functional MESS score >= seven with the reconstructed member. METHODS: We included in the study, patients with open fractures Gustilo IIIB and IIIC of the leg with criteria for seriously injured lower limb modified by Gregory and Bonanni and MESS score >= seven. All patients were included from 2003 to 2006. Patients were evaluated through the Functional Independence Measure and Pain Disability Index. RESULTS: From selected 26 patients, five had below knee amputation and 21 after reconstructive procedures got limb salvage. Nine patients were evaluated after 10 years follow-up. Seven of them have the reconstructed limb, only one of these was considered as functional failure. Of the patients with lower limb reconstruction only Gustilo IIIC open fracture has a non-functional member. The two patients with amputation also have functional results. CONCLUSION: MESS is not a proper instrument to indicate amputation

La recherche technologique au service du handicap est devenue une priorité nationale de santé publique. La Médecine Physique et de Réadaptation, qui prend notamment en charge les altérations du système neuromusculaire, est directement concernée par cet enjeu médico-sociétal. Parmi les disciplines qu'elle coordonne, la kinésithérapie occupe une place fondamentale, participant en particulier au diagnostic et à la thérapeutique des troubles du contrôle de la posture.<br />Dans ce contexte, ce travail doctoral a visé au développement et à la validation de solutions biomédicales innovantes d'amélioration du contrôle de la posture bipédique de personnes souffrant d'une altération de leur système sensori-moteur.<br />La mise en place de ces solutions nécessitant l'établissement préalable d'évaluations posturales objectives, fiables, valides et utilisables, ainsi que de fondements théoriques scientifiquement établis présumant de leur efficacité, trois objectifs complémentaires ont été poursuivis.<br />Sur un plan méthodologique, d'une part, notre travail a permis de proposer un protocole et des paramètres fiables, valides, utiles et utilisables d'évaluation posturographique des capacités de contrôle de la posture bipédique à des fins de diagnostic et de suivi des prises en charge.<br />Sur un plan fondamental dans le domaine des neurosciences comportementales, d'autre part, notre travail a permis une meilleure compréhension des mécanismes mis en jeu dans le contrôle de la posture bipédique.<br />Sur un plan appliqué à la clinique, enfin, les résultats de ces travaux nous ont permis de développer, mettre en place et évaluer l'efficacité d'une prise en charge à court terme fondée sur l'exploitation du paradigme de suppléance perceptive et dédiée à la compensation des déficits posturaux chez les personnes atteintes de lésion vestibulaire et chez les personnes amputées du membre inférieur.

<p>The high prevalence of diabetes mellitus among the Sudanese population is linked to obesity, poor glycaemic control and a high rate of complications. This study investigated 1/ Leptin hormone and its correlations with different biochemical characteristics in Sudanese diabetic subjects, 2/ The impact of glycaemic control on pregnancy outcome in pregnancies with diabetes, 3/ The glycaemic response to Sudanese traditional carbohydrate foods, 4/ The influence of glucose self-monitoring on the glycaemic control among this population, 5/ The health related quality of life in Sudanese subjects with diabetes-related lower limb amputation. </p><p>Leptin was significantly lower in diabetic subjects compared with controls of same BMI in both females (P =0.0001) and males (P =0.019). In diabetic subjects, serum leptin correlated positively with the homeostatic assessment (HOMA) of both beta-cell function (P =0.018) and insulin resistance (P =.038). In controls, leptin correlated only with insulin resistance. Pregnancy complications were higher among diabetic compared with control women (P<0.0001) and varied with the type of diabetes. Infants of diabetic mothers had a higher incidence of neonatal complications than those of non-diabetic women (P<0.0001). In six Sudanese traditional carbohydrate meals over all differences in incremental AUCs were significant for both plasma glucose (P = 0.0092) and insulin (P = 0.0001). Millet porridge and wheat pancakes displayed significantly lower post-prandial glucose and insulin responses, whereas maize porridge induced a higher post-prandial glucose and insulin response. In type 2 diabetic subjects SMBG or SMUG was not related to glycaemic control. In type 1 diabetic subjects, SMBG was significantly associated with better glycaemic control, as assessed by HbA1c (P=0.02) and blood glucose at clinic visits (P=<0.0001), similar associations were found for SMUG respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level. Diabetic subjects with LLA had significantly poorer HRQL compared to a reference diabetic group (P=<0.0001). Duration of diabetes and amputation had negative impact on HRQL in subjects with LLA (P=<0.0001) respectively. Diabetic subjects with LLA had decreased sense of coherence and high presence of symptoms. Improving health services at the primary level is important to reduce the complications and burden of disease in the Sudanese population.</p>

The high prevalence of diabetes mellitus among the Sudanese population is linked to obesity, poor glycaemic control and a high rate of complications. This study investigated 1/ Leptin hormone and its correlations with different biochemical characteristics in Sudanese diabetic subjects, 2/ The impact of glycaemic control on pregnancy outcome in pregnancies with diabetes, 3/ The glycaemic response to Sudanese traditional carbohydrate foods, 4/ The influence of glucose self-monitoring on the glycaemic control among this population, 5/ The health related quality of life in Sudanese subjects with diabetes-related lower limb amputation. Leptin was significantly lower in diabetic subjects compared with controls of same BMI in both females (P =0.0001) and males (P =0.019). In diabetic subjects, serum leptin correlated positively with the homeostatic assessment (HOMA) of both beta-cell function (P =0.018) and insulin resistance (P =.038). In controls, leptin correlated only with insulin resistance. Pregnancy complications were higher among diabetic compared with control women (P&lt;0.0001) and varied with the type of diabetes. Infants of diabetic mothers had a higher incidence of neonatal complications than those of non-diabetic women (P&lt;0.0001). In six Sudanese traditional carbohydrate meals over all differences in incremental AUCs were significant for both plasma glucose (P = 0.0092) and insulin (P = 0.0001). Millet porridge and wheat pancakes displayed significantly lower post-prandial glucose and insulin responses, whereas maize porridge induced a higher post-prandial glucose and insulin response. In type 2 diabetic subjects SMBG or SMUG was not related to glycaemic control. In type 1 diabetic subjects, SMBG was significantly associated with better glycaemic control, as assessed by HbA1c (P=0.02) and blood glucose at clinic visits (P=&lt;0.0001), similar associations were found for SMUG respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level. Diabetic subjects with LLA had significantly poorer HRQL compared to a reference diabetic group (P=&lt;0.0001). Duration of diabetes and amputation had negative impact on HRQL in subjects with LLA (P=&lt;0.0001) respectively. Diabetic subjects with LLA had decreased sense of coherence and high presence of symptoms. Improving health services at the primary level is important to reduce the complications and burden of disease in the Sudanese population.

We have designed and examined a compliant knee mechanism that may offer solutions to problems that exist for infants and toddlers who are just learning to walk. Pediatric prosthetic knees on the market today are not well designed for infants and toddlers for various reasons. Children at this age need a prosthetic that is light in weight, durable, and stable during stance. Of the eleven knees on the market for children, all but three are polycentric or four-bar knees, meaning they have multiple points of movement. Polycentric knees are popular designs because they offer the added benefit of stable stance control and increased toe clearance, unfortunately this type of knee is often too heavy for young children to wear comfortably and is not well suited for harsh environments such as sand or water, common places children like to play. The remaining three knees do not offer a stance control feature and are equally vulnerable to harsh environments due to ball bearing hinges. Compliant mechanisms offer several design advantages that may make them suitable in pediatric prosthetic knees -- light weight, less susceptible to harsh environments, polycentric capable, low part count, etc. Unfortunately, they present new challenges that must be dealt with individually. For example compliant mechanisms are typically not well suited in applications that need adjustability. This problem was solved by mixing compliant mechanism design with traditional mechanism design methods. This paper presents a preliminary design concept for a compliant pediatric prosthetic knee. The carbon fiber composite spring steel design was first built and then evaluated using Finite Element Analysis. The prototype's instant center was plotted using the graphical method. From our analysis position, force and stress information was gathered for a deflection up to 120 degrees. The instant centers that were plotted indicate that the knee has good potential in offering adequate stability during stance.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Analyse de la marche des personnes amputées de membre inférieur en situations contraignantes de la vie couranteRESUME : Le projet se situe dans le contexte du handicap moteur et plus spécifiquement concerne les personnes amputées de membre inférieur. Une autonomie de déplacement est redonnée aux patients grâce à l'appareillage et la rééducation qui restituent une partie des fonctions locomotrices. Cependant, l'autonomie des personnes amputées de membre inférieur est limitée par des situations plus contraignantes que la marche sur sol plat (plans inclinés, escaliers, dévers) et rencontrées quotidiennement. Le développement de nouveaux composants prothétiques et protocoles de rééducation peut permettre de réduire les difficultés des patients dans ces situations. Au préalable, il est nécessaire de comprendre le comportement du système ostéo-articulaire et des composants prothétiques lors de la locomotion en situations contraignantes de la vie courante. L'analyse quantifiée de la marche a été utilisée dans cet objectif de caractérisation de la locomotion. Les travaux de thèse s'inscrivent dans un projet de trois ans financé par l'ANR en partenariat avec deux centres d'appareillage et de recherche clinique, le INI-CERAH (Centre d'Études et de Recherche Appareillage des Handicapés) et l'IRR (Institut Régional de Médecine Physique et de Réadaptation), et un industriel, l'entreprise Proteor fabricant de composants prothétiques. Un protocole permettant d'étudier la locomotion et les adaptations de la locomotion entre cinq situations différentes de la vie courante a été mis en place. Une base de données unique et d'envergure, au vue de la littérature, a été créée. Elle regroupe les paramètres de la marche de 22 sujets amputés transtibiaux, de 21 sujets amputés transfémoraux et 30 sujets contrôles, ayant suivi le même protocole. Des paramètres biomécaniques ont été identifiés pour caractériser les adaptations de la locomotion des sujets amputés entre le plat et le dévers et la pente par comparaison aux adaptations des sujets contrôles entre le plat et ces situations. Cette méthode d'analyse novatrice permet d'appréhender la locomotion d'un groupe de sujet en tenant compte de la marche propre à chaque individu du groupe. Ces travaux de thèse apportent un protocole, une base de données et un complément de connaissances sur les mécanismes mis en jeu lors de la locomotion en pente et en dévers.Mots clés : Amputation, Appareillage, Biomécanique, Locomotion, Dévers, Pentes

Title: Assessment of the effect of CDP training in patient after lower extremity amputation Objectives: The aim of this diploma thesis is to describe the influence of the individually set training programme on the computerized dynamic posturography (CDP) NeuroCom Smart EquiTest System (further referred to as EquiTest) independent of traditional therapeutic exercises in the patient after unilateral transfemoral amputation of the lower limb and to monitor the effect of this training on postural behaviour, ability of functional mobility and balance, frequency of falls and balance confidence in an individual after amputation. Methods: This is an experimental pilot case study that monitors the effect of an individually designed five-week training programme (with a frequency of exercises 2 times a week) on the EquiTest in one patient after unilateral transfemoral amputation of the lower limb. Examination of postural functions was performed by the EquiTest using SOT, MCT, and LOS tests. The ability of functional mobility and balance was tested using the functional Timed up and go test (TUG). The frequency of falls was detected from the proband's medical history. The balance confidence was determined using the Activities specific balance confidence scale (ABC). All measurements were made in two terms, i.e....

Made available in DSpace on 2016-12-12T17:32:59Z (GMT). No. of bitstreams: 1 RESUMO KADINE.pdf: 15853 bytes, checksum: bfa11d3fee681ef7c30a44a0738800d9 (MD5) Previous issue date: 2015-12-10 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Os estudos de Carga Global da Doença (GBD) alertam que idosos com doenças crônicas irão viver mais, porém com incapacidades como é o caso das amputações de membros inferiores atribuíveis ao diabetes mellitus (DM). O objetivo deste estudo foi estimar a GBD para as amputações de membros inferiores atribuíveis ao DM no Estado de Santa Catarina, no período de 2008 a 2013. Realizou-se um estudo epidemiológico descritivo de base hospitalar, utilizando o cálculo de DALY (disability adjusted life years). A partir das Autorizações de Internação Hospitalar no período de 2008 a 2013, foram incluídas pessoas submetidas à cirurgia de amputação nos hospitais públicos do Estado de Santa Catarina e a prevalência do óbito por DM registrados no sistema de informação de mortalidade nesse período. Ocorreram 1.183 amputações de membros inferiores em pessoas com DM nos últimos 6 anos considerando-se todas as microrregiões do Estado de Santa Catarina. A carga revelou-se elevada e a morbidade foi a principal responsável por mais de 8 mil anos de vida sadia perdidos (93% do DALY), em homens e mulheres acima de 60 anos de idade com maior impacto na expectativa de vida de homens. Estimamos a GBD de uma população majoritariamente idosa que envelhecerá com a amputação de membro Inferior. Assim, há necessidade de assistência planejada a partir de intervenções reabilitadoras em tempo real, levando em consideração que as distribuições das taxas de DALY nas 20 microrregiões do estado não mostraram distribuição homogênea. Alerta-se para a criação de equipes multidisciplinares para a identificação precoce do pé diabético, além da necessidade de capacitação das equipes na atenção especializada e ampliação da atuação do fisioterapeuta na reabilitação pré e pós-protetização.