The aim of this thesis was to determine the effect of driving in a wheelchair and walking on crutches on the energy expenditure and cardiopulmonary system in people with lower limb amputation. For this measurement we used a device Metamax 3B made by Cortex, functioning by measuring the concentration of oxygen and carbon dioxide in the breathing air, and a sporttester made by Polar. On the basis of oxygen consumption is possible to determine an energy expenditure during the activity. Our study was attended by 11 probands (men), patient of long-term hospital in Motol Hospital. Nine probands were amputated from vascular causes, one from the traumatological causes and one from the other causes. Probands rode (or walked) for four minutes back and forth along the corridor thirty meters long. They were instructed to ride (walk) at a speed to fit their needstand to also keep the same pace for a defined period of time. Walking on crutches without prosthesis managed only three of the testing file. During the study, these values were measured: distance traveled, average speed, oxygen consumption (VO2, VO2/kg, VO2 peak), carbon dioxide output (VCO2), respiratory exchange ratio (RER), tidal volume (VT), breathing frequention (BF), minute ventilation (MV), heart rate (HR), energy expenditure and performance. In this work...

The number of patients with diabetes mellitus has been increasing recently. The so-called diabetic leg and related amputation treatment belong to the complications of the disease. Amputation or removal of the end part of a limb obviously affects not only the physical aspect of a patient, but also the psychical, social and spiritual aspects. It is therefore vital that each nurse is able to choose from suitable techniques of communication with such patients and to provide them with sufficient support in the adaptation to a new life role. Callista Roy also dealt with this issue and developed a model named after her, which can be applied to patients adapting to a newly arisen situation, which amputation of a lower limb definitely is. Three goals were set in the thesis. The first one was to find out what kind of problems patients after amputation of a lower limb see in the individual adaptation modes according to C. Roy. Then we focused on the interventions applied by nurses to the support for the adaptation in the individual adaptation modes and to what extent nurses work with stimuli in Roy's conception. The research was based on the data collection by means of a qualitative method, the techniques of semi-structured interviews, and involved observation of patients after amputation of a lower limb and of nurses working at a standard surgery department. After the saturation of the research sample set the data was analysed and processed by means of the "pencil & paper" method. The research has shown that nurses devote particular attention to the physiologic adaptation mode and to the interdependence mode in their practice. In terms of the satisfaction of the basic physiologic needs they mostly mentioned the assistance in self-service activities, in the sphere of excretion and very often also interventions contributing to pain relief. In the self-concept group identity adaptation mode nurses mostly apply suitable communication and provision of sufficient information. In terms of the role function adaptation mode we can say that nurses search for this kind of information, but no activity supporting this mode was found among the nurses. Unlike nurses, who pay the highest attention to the satisfaction of the physiologic adaptation mode and thereto related interdependence mode, patients see shortcomings in all four adaptation modes. In the physiologic adaptation mode patients mostly pointed out problems with movement manifested themselves in the deficit of self-care. In the sphere of self-concept group identity, they mentioned the feeling of helplessness and inferiority. Nearly all patients see a problem in the dependence on the nursing staff and the disability to play the roles once played. Among the most frequent stimuli affecting a patient after lower limb amputation are pains that nurses relieve by means of analgesics prescribed by physicians, patients also often mention the approach of the staff and social interaction owing to the absence of family members. The research has shown that nurses approach patients with dignity and also respect the incoming visitors. The information obtained by this research can be used as a basis for seminars focused on this issue and lead to the improvement of the nursing care about patients with amputation of a lower limb.

Estudo quantitativo, descritivo e retrospectivo de internações hospitalares de pacientes com e sem o diagnóstico de diabetes submetidos a amputação não traumática de extremidades inferiores, no período de 2001 a 2008, em Ribeirão Preto - SP - Brasil. Este estudo teve como objetivos caracterizar as internações hospitalares de pacientes com e sem o diagnóstico de diabetes mellitus submetidos a amputação não traumática de extremidades inferiores segundo sexo, idade, período da internação hospitalar, tipo de atendimento e condições da alta; relacionar as internações hospitalares com as variáveis tipo de alta e atendimento, sexo, idade e tempo de internação, e analisar a tendência das internações hospitalares em Ribeirão Preto-SP, no período de 2001-2008. Utilizaram-se dados de fonte secundária de internações hospitalares, do Sistema de Informações do Centro de Processamento de Dados Hospitalares. Os resultados mostraram que das 2296 internações hospitalares relacionadas ao procedimento de amputação não traumática de extremidades inferiores, 954 (41,6%) tinham o diagnóstico de diabetes mellitus. A maioria (58,7%) é do sexo masculino; idade média de 63,9 anos; 54,8% residiam em Ribeirão Preto-SP e 72,6% receberam assistência hospitalar pelo Sistema Único de Saúde. O tempo de internação hospitalar variou de 0 a 128 dias, média de 9,9 dias. A taxa de reinternações foi de 12,7% e de óbito 7,9%. A tendência de internações hospitalares não obedece a um padrão regular e o modelo de regressão linear ajustado para verificar a existência de tendência não mostrou significância estatística. O teste Qui-quadrado apresentou significância estatística, p-valor < 0,001, para variável sexo e o teste de Mann-Whitney mostrou significância estatística p-valor <0,001 para o tempo de internação hospitalar. Esses resultados apontam a importância de reforçar as ações de educação aos pacientes com diabetes mellitus com vistas à prevenção de amputações como desfecho da doença / Quantitative, descriptive and retrospective study of hospital admissions of patients with and without a diagnosis of diabetes mellitus undergoing non-traumatic amputation of the lower extremities, in the period from 2001 to 2008 in Ribeirão Preto - SP - Brazil. This study aimed to characterize the hospital admissions of patients with and without a diagnosis of diabetes undergoing non-traumatic amputation of lower extremities by sex, age, hospitalization time, type of care and discharge conditions; relate the hospitalizations with the variable type of discharge and attendance, sex, age and hospitalization time and analyze the tendency of hospital admissions in Ribeirão Preto-SP, in the period from 2001 to 2008. Source of data were used secondary hospitalizations, from the National Hospital Data Processing Center Information. Of 2296 hospital admissions related to non-traumatic amputation procedure of the lower extremities, 954 (41.6%) had a diagnosis of diabetes mellitus, most (58.7%) were male, mean age 63.9 years. 54.8% live in Ribeirão Preto-SP, 72.6% received hospital care by SUS, hospital stay ranging from 0 to 128 days, an average of 9.9 days. The readmission rate was 12.7% and 7.9% died. The trend of hospitalizations did not follow a regular pattern and the linear regression model adjusted to check the trend was not statistically significant.The chi-square test was statistically significant, p <0.001, for gender variable and the Mann-Whitney test revealed statistically significant p-value <0.001 for the variable hospital stay. These results show the importance of strengthening education activities to patients with diabetes in order to prevent amputations as the outcome of the disease

Este estudo avalia a qualidade de vida de sujeitos acometidos por tumores musculoesqueléticos de membros inferiores, submetidos a cirurgias de ressecção, com salvamento de membro ou amputação. A casuística foi composta por 56 sujeitos, avaliados no período de 14 meses (agosto de 2011 a setembro de 2012), que foram divididos em três grupos: 1- 12 amputados; 2- 16 em pós-operatório de salvamento do membro (colocação de endoprótese ou reconstrução biológica); 3- sujeitos saudáveis (sem diagnóstico de câncer), selecionados entre a população em geral, de forma pareada com os outros grupos, segundo sexo, idade, escolaridade e condição socioeconômica. Além do Critério de Classificação Econômica Brasil (2010), foram aplicados dois protocolos de avaliação, um de qualidade de vida (Medical Outcomes Study 36 - Item Short-Form Health Survey - SF-36) e o outro de capacidade funcional (Toronto Extremity Salvage Score - TESS), ambos adaptados culturalmente e validados no Brasil. Os dados foram estatisticamente analisados, conforme preconizado por cada protocolo. Os resultados indicaram que ambos os tipos de abordagem cirúrgica (amputação ou reconstrução) produziram prejuízos na capacidade funcional e na qualidade de vida dos sujeitos acometidos por tumores musculoesqueléticos, quando comparados à população saudável. Diferentemente do que apontaram outros trabalhos internacionais com casuística semelhante, os sujeitos submetidos a amputações apresentaram resultados melhores relacionados à sua capacidade funcional e à qualidade de vida, na maioria dos domínios do SF36 e com relevância estatística (p=0,001) no escore final do TESS, do que aqueles submetidos a técnicas de salvamento de membro. Por fim, é importante analisar a percepção dos sujeitos sobre sua funcionalidade e qualidade de vida, de modo a encontrar caminhos mais adequados no processo de reabilitação desta população. / This study appraises the quality of life of individuals with musculoskeletal tumors in lower extremities, undergoing resection surgeries with extremity salvage or amputation. The casuistry was composed by 56 subjects assessed in the course of 14 months (from August, 2001 to September, 2012), who were divided into 3 groups: 1- 12 amputated; 2- 16 in postsurgical extremity salvage (endoprosthesis implant or biological reconstruction); 3- healthy subjects (without cancer diagnosis), selected from the whole population, paired off with other groups, according to sex, age, schooling and socioeconomic status. Besides the Critério de Classificação Econômica Brasil (2010), two assessment protocols were applied, one about quality of life (Medical Outcomes Study 36 - Item Short-Form Health Survey - SF-36), and the other one about functional capacity (Toronto Extremity Salvage Score - TESS), both culturally adapted and validated in Brazil. The data were statistically analyzed according to what each protocol proclaims. The results revealed that both surgical approach types (amputation or reconstruction) caused harm to the functional capacity and to the quality of life of the subjects suffering from musculoskeletal tumors, when compared to the healthy population. Unlike what other international papers with similar casuistry have shown, the subjects undergoing amputation presented better results related to their functional capacity and quality of life, in the majority of the domains of SF36, with statistical relevance (p=0.001), than those submitted to the techniques of extremity salvage. Finally, it is important to analyze the subjects\' perception on their functionality and quality of life in order to discover the most suitable ways in the process of rehabilitating this population.

O objetivo deste estudo foi traduzir e adaptar culturalmente o Functional Measure for Amputees Questionnaire (FMA) para a população brasileira e analisar sua validade e eficácia quando aplicado em pacientes amputados de membro inferior. Métodos: O procedimento seguiu as etapas: tradução para o português, retrotradução, análise das versões por um comitê multidisciplinar e pré-teste. O questionário traduzido foi aplicado na amostra de 44 pacientes, 27 no nível transtibial e 17 transfemoral, idade média de 47,5 ±17,2 anos; em 20 pacientes a causa da amputação foi trauma, 17 por insuficiência vascular, quatro por infecção e três por tumor. O tempo médio de reabilitação foi de 6,2 meses. Foram realizadas as análises de confiabilidade teste-reteste e consistência interna. Resultados: O resultado da adaptação transcultural foi satisfatório; algumas modificações foram necessárias, porém sem nenhuma mudança na estrutura ou no conteúdo do questionário original; no estudo da confiabilidade verificamos que em média, os coeficientes Kappa foram superiores a 0,80 e 25% deles foi igual a um indicando haver excelente concordância inter e intra-entrevistadores. Na análise da consistência interna, o valor do coeficiente para a questão referente ao Índice da Capacidade Locomotora foi igual a 0,79 demonstrando haver consistência no bloco de questões relacionadas à mobilidade. Conclusão: Os resultados sugerem que a versão brasileira do FMA pode ser um instrumento confiável para medir o resultado funcional de pacientes brasileiros com amputação de membro inferior após a reabilitação. / The aim of the study was to translate a cross-cultural version of the Functional Measure for Amputees Questionnaire (FMA) into Brazilian-Portuguese and evaluate its reliability and validity for assessing lower limb amputees patients. Methods: The FMA were translated, back-translated, evaluated by a multidisciplinary committee and pre-tested. The translated e adapted version was submitted to field test on a study group composed of 44 lower limb amputees patients; their average age was 47,5±17,2. The amputation level was transtibial in 27 patients and 17 in transfemoral patients. The cause of amputation related to trauma in 20 individuals, 17 with vascular insufficiency, four infection and three with malignant tumor. The average of physical therapy treatment was 6,2 months. Test-retest reliability, internal consistency was investigated. Results: the cultural adaptation of the FMA was successfully accomplished. In the field test the inter- and intra-observer showed high reliability; the mean of kappa values was superior to 0,80 and in 25% of the questionnaire was one suggesting excellent agreement beyond chance. The internal consistency for the question about Locomotor Capabilities Index was 0,79 showing a consistency in relation to mobility. Conclusion: the Brazilian-Portuguese version of the FMA questionnaire appears to be culturally appropriate and the adapted instrument demonstrated to be a reliable instrument to measure the functional outcome of Brazilian lower limb amputees patients after rehabilitation.

Amputation av nedre extremitet drabbar cirka 2600 individer i Sverige årligen. Amputation är en stor operation som innebär en rad förändringar som exempelvis nya fysiska hinder och förändrade känslor kring sig själv och sin omgivning. Syftet med studien är att belysa individers upplevelser av livet efter en amputation av nedre extremitet. Studien är en litteraturöversikt gjord på kvalitativa artiklar där tio artiklar valdes ut och analyserades med hjälp av Fribergs (2006) analysmetod. Detta resulterade i tre huvudteman Att förlora ett ben som beskriver de känslor och problem som individerna upplever i samband med amputation. Förändrad självbild handlar om hur individen ser på sig själv och hur de uppfattar att andra ser på dem. Det sista temat, Att återfå kontroll, beskriver hur individen återfår sin självständighet och nytt hopp som gått förlorad efter amputationen. Författarna har i diskussionen fokuserat på att diskutera kring vad sjuksköterskan bör tänka på i mötet med dessa individer och vad sjuksköterskan kan göra för att hjälpa dem att återfå sin självständighet och hopp om framtiden. / Program: Sjuksköterskeutbildning

Amputation innebär en kroppslig förändring som inte enbart medför en funktionsnedsättning utan även påverkar den subjektiva upplevelsen av kroppen. De personer som genomgår en benamputation utgör en relativt liten patientgrupp sett ur ett samhällsperspektiv, trots detta är den påföljande rehabiliteringen både tidskrävande och kostsam. I sjuksköterskans arbete ingår att tillgodose patienters unika behov samt att i rehabiliteringsarbetet, understödja patienters egna resurser. Det är således viktigt för sjuksköterskan att nå ökad förståelse för de upplevelser som är förenade med en amputation samt att ha kunskap om de faktorer som kan bidra till en hälsosam rehabilitering. Syftet med denna studie är att utifrån ett patientperspektiv belysa upplevelser av benamputation. Studien bygger på analys av vetenskapligt granskade intervjustudier. Materialet är analyserat utifrån Evans (1997) kvalitativa innehålls- analys. De tre huvudteman som har framkommit i denna studie är: Initiala reaktioner på den levda kroppens förändring, Betydelsen av andras närvaro i efterförloppet av amputationen samt Att gradvis acceptera sin nya livssituation. Dessa huvudteman påvisar att de upplevelser som följer en amputation är bundna till patienters förväntningar, förberedelse, förkunskap samt var i rehabiliteringsprocessen patienten befinner sig. I resultatdiskussionen diskuteras sedan de faktorer som kan bidra till en hälsosam rehabilitering samt hur de benamputerade upplever vikten av dessa faktorer. Vidare diskuteras hur ökad kunskap och förståelse för dessa patienters upplevelser kan användas i det praktiska vårdarbetet och förhoppningsvis förkorta rehabiliteringstiden för denna patientgrupp. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

I Sverige amputeras cirka 2500 personer varje år, 80 procent av dessa beror på cirkulationsrubbningar, andra orsaker kan vara trauma eller olycka. Vi lever genom våra kroppar och när kroppen förändras kommer även livsvärlden att förändras. När en person genomgår en plötslig amputation påverkas personens välbefinnande och det blir också en omtumlande upplevelse att tvingas in i en ny livssituation, då arbetsliv, sociala livet och personliga livet påverkas av skadan. Då sjuksköterskans uppgift är att främja patientens hälsa och minska dennes lidande, är det viktigt att han/hon vet hur det är att ha drabbats av en plötslig amputation och hur patientens livsvärld har förändrats. Syftet med denna studie är att beskriva hur patienter upplever att livsvärlden förändrats efter en plötslig amputation. En kvalitativ litteraturstudie användes som metod för att få en ökad förståelse för det valda fenomenet. Resultatet presenteras i teman och subteman, dessa visar på att en person som drabbats av plötslig amputation genomgår en fysiskt och psykisk förändring, personen måste lära sig att anpassa sig till detta. Personerna som genomgått en amputation använde olika strategier för att hantera det som inträffat, exempelvis; träffa och samtala med andra som genomgått amputation eller söka stöd hos anhöriga. Det som var viktigast för alla informanterna var att uppfattas som normala av omgivningen och de ville inte bli stämplade som ett handikapp. En viktig del i detta var att ha en välanpassad protes. I diskussionen ges praktiska implikationer samt förslag på nya forskningsfrågor. / Program: Sjuksköterskeutbildning

Varje år genomgår cirka 2600 personer i Sverige en benamputation. Orsakerna är oftast trauma, kärlsjukdomar eller tumörsjukdomar. Det är flera delar i livet som påverkas av en amputation, den sociala och fysiska aspekten är två av dessa. Det finns flera olika strategier för att bearbeta förlusten av ett ben. Denna uppsats avser att ge sjuksköterskan en bättre förståelse för patientens situation, vilket gör att sjuksköterskan kan erbjuda en bättre vård till patienten. Syftet med denna studie är att beskriva patientens upplevelser efter en amputation i de nedre extremiteterna. Vi har valt att göra en litteraturstudie enligt Friberg (2002) modell med åtta kvalitativa studier. Resultatet är uppdelat i åtta teman vilka representerar de olika områden i livet som påverkas av en amputation. Det är viktigt att känna till att processen för återhämtning börjar redan innan operationen. Efter amputationen är stödet från familj och vänner väldigt viktigt då man upplever både fysiska och psykiska hinder. Efter en amputation uppstår flera känslor vilket kan medföra bristande självförtroende och minskad självständighet. De flesta upplever smärta efter amputationen, ofta är det smärta i stumpen som kommer av protesanvändning. Även om en protes kan ge mycket smärta så kan en välanpassad protes förenkla vardagen. Olika sätt att hantera situationen är genom att aktivera sig, ha en positiv inställning och smärtlindring. I diskussionen behandlas metoden och resultatet. Vi reflekterar över resultatet och återkopplar till bakgrunden. / Program: Sjuksköterskeutbildning

Este trabalho tem como objetivo discutir as possibilidades e dificuldades de um psicanalista quando passa a compor uma equipe multidisciplinar de atendimento a pacientes amputados em reabilitação com prótese. A equipe de saúde tem papel fundamental no atendimento ao paciente amputado que realiza reabilitação. Pensa-se que há diferença para este trabalho o fato de haver na equipe um psicanalista, que atua de um lugar diferente dos outros membros, representantes do discurso médico. Para se compreender o que ocorre quando há um psicanalista na equipe de saúde são abordadas as diferenças entre os campos da psicologia hospitalar e da psicanálise dentro de uma equipe; as diferenças entre os discursos médico e psicanalítico, o estatuto do corpo para a psicanálise, e as bases de sustentação para que um analista se constitua enquanto tal. Além disso, são tratados o estatuto do corpo na contemporaneidade e a questão da deficiência, pontos cruciais no atendimento ao paciente com amputação. Por último, busca-se uma compreensão, do ponto de vista psíquico, para a amputação e reabilitação do paciente, levando-se em conta que o atendimento prestado a ele é permeado pelas questões enfrentadas pela equipe multidisciplinar / This paper aims to discuss the possibilities and difficulties of a psychoanalyst when she begins to compose a multidisciplinary team to care of patients with amputation in rehabilitation with a prosthesis. The health team has a key role in patient care that is in rehabilitation. It is thought that there is a difference to the treatment if there is a psychoanalyst in this team, who works in a different way from the other members, representatives of medical discourse. To understand what happens when there is a psychoanalyst in the health care team, this paper points the differences between the fields of health psychology and psychoanalysis within a team, the differences between the medical and psychoanalytical discourses, the status of the body for psychoanalysis and bases of support for an analyst to be constituted as such. Moreover, this paper treats about the status of the body in contemporary and deficiency issues, what is crucial for the patient with amputation. Finally, it seeks an understanding of the psychological point of view of amputation and rehabilitation of the patient, taking into account that the service provided to him is permeated for issues facing the multidisciplinary team