Made available in DSpace on 2014-07-29T15:29:14Z (GMT). No. of bitstreams: 1 Analise Biomecania da Inicializacao da Marcha de Amputados Transtibiais Protetizados.pdf: 3970642 bytes, checksum: afbedb9e27d84f4cdd22ab374f81a8c5 (MD5) Previous issue date: 2012-03-30 / The amputee patient undergoes several changes after the amputation, not only physical but also emotional and socioeconomic, requiring the use of prosthesis. One of the physical changes that affects the amputee's gait when using your prosthesis ambulation is compromised. The march is the natural way that humans use to move from one location to another. The march is a complex activity because it depends on a series of interactions between the two lower limbs multithreaded and total body mass. Therefore, assessing the impact of the use of prostheses in locomotor through the analysis of strategies for startup of the march transtibial amputees. We evaluated the speed and displacement of the COP, knee and ankle angles of the support member during initialization of the march. For the kinematic analysis was set 34 markers on anatomical landmarks of interest, two AMTI force platforms. For statistical analysis we used the Student t test and correlation between variables. Difference was only statistically significant variables in the knee angle and average speed side. The absence of a flexible ankle joint may result in limitations in the function of the prosthesis. Amputees to achieve an adequate control in propulsion and balance it was necessary to use several strategies to adjust. The prosthesis provided by SUS serves its purpose, which is to provide a walking person. But this improvement in the ankle joint can facilitate the process of walking boot. Another fact of great importance is the frequent evaluation of prosthetic to verify the necessary adjustments of the prosthesis. / O paciente amputado sofre várias alterações após a amputação, não somente físicas, mas também emocionais e socioeconômicas, sendo necessário que a utilização de prótese. Uma das alterações físicas que acomete o amputado é a locomoção quando da utilização de prótese a sua deambulação fica comprometida. A marcha é o meio natural que o ser humano utiliza para se deslocar de um local para outro. A marcha é uma atividade complexa porque depende de uma série de interações entre os dois membros inferiores multissegmentados e a massa total do corpo. Assim sendo, avaliar o impacto da utilização de prótese no aparelho locomotor por meio da análise das estratégias de inicialização da marcha em amputados transtibiais. Foram avaliados a velocidade e deslocamento do COP, ângulos do joelho e tornozelo do membro de apoio durante a inicialização da marcha. Para a análise cinemática foi fixado 34 marcadores em pontos anatômicos de interesse, mais duas plataformas de força AMTI. Para a análise estatística foi utilizado o test t de Student e a correlação entre as variáveis. Foi encontrada diferença estatística somente nas variáveis ângulo do joelho e velocidade médio lateral. A ausência de uma articulação do tornozelo flexível pode resultar em limitações na função da prótese. Os amputados para alcançar um adequado controle na propulsão e equilíbrio houve a necessidade a utilização de várias estratégias de ajustamento. A prótese fornecida pelo SUS atende o seu propósito, que é fornecer uma deambulação ao indivíduo. Porém a melhoria desta na articulação do tornozelo pode facilitar o processo de inicialização da marcha. Outro fato de grande importância é a freqüente avaliação do protetizado a fim de verificar os ajustes necessários da prótese.

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

Ce travail porte sur deux thèmes principaux. Le premier est relatif à la drépanocytose et comprend deux études. La première a examiné les connaissances qu’ont 178 hommes et femmes vivant au Bénin sur la maladie, ses causes, ses effets et sa prise en charge. Ils ont répondu à un questionnaire et, leurs réponses ont été comparées à celles d’un groupe d’expert. Il en est ressorti qu’il existait une méconnaissance globale de la maladie, et plus particulièrement de ses symptômes les plus graves et de son traitement. Les résultats révèlent que plus on a un niveau d’éducation élevé, moins on se fait de fausses idées concernant la maladie. En outre, cette méconnaissance était plus accrue chez les personnes se déclarant porteuses du trait génétique (4.83) ou drépanocytaire (5.19) que chez les personnes ayant déclaré ne pas être porteuses (3.72) ou saines (3.62). La deuxième étude a quant à elle cherché à savoir si les 137 personnes interrogées vivant au Bénin, avaient intégré de façon adéquate les règles de transmission génétique de la maladie, en se basant sur la théorie fonctionnelle de la cognition. L’analyse des données a permis de distinguer trois clusters distincts. Dans le premier groupe (n=46), les personnes jugeaient ainsi le risque de transmission de la maladie plus élevé en présence de l’un ou l’autre des deux parents atteints. Dans le deuxième groupe (n=51), le risque était jugé d’autant plus grand que chacun des parents était lui-même gravement atteint. Dans le troisième groupe (n=40), le risque n’avait été jugé élevé qu’en présence des deux parents atteints. Le deuxième thème a donné lieu à une étude, visant à examiner les motifs pouvant sous-tendre un refus d’amputation chez 224 personnes vivant au Bénin, par l’approche de la théorie du renversement. Les résultats montrent que la peur de la perte de l’identité personnelle, la peur des hôpitaux et du personnel médical, la conviction que la chirurgie était inutile, le manque de confiance dans la compétence et le dévouement des médecins, la peur de la perte de l’estime de l’autre et celle de la perte de la force spirituelle, font partie des facteurs principaux pouvant motiver un refus d’amputation. / This thesis focuses on two main themes. The first one is related to sickle cell disease and the second theme is related to limb amputations. For studying the first theme, this research proposes to examine the knowledge of 178 men and women living in Benin, on the disease, its causes, effects and care. They answered a questionnaire and their responses had been compared to those given by an expert group. It had been found that there was an overall lack of awareness on the disease, and especially its most severe symptoms and treatment. The results reveal that the higher level of education they have, the less misconceptions about the disease they have. In addition, this ignorance was increased by people declaring themselves carrying the genetic trait (4.83) or sickle cell (5.19) than those who reported not being carriers (3.72) or healthy (3.62). The second study about the first theme, investigated whether the 137 respondents living in Benin had integrated adequately the rules of inheritance of the disease, based on the functional theory of cognition. Three distinct clusters emerge with data analysis. In the first group (n=46), respondents considered a higher risk of transmission if the one or the other of two parents was/were affected by the disease. In the second group (n=51), the risk was considered even greater as both parents were seriously ill. In the third group (n=40), the risk was considered as high only if both parents were touched. The second theme, Accidents involving physical injury, has motivated a study which aim was to examine the reasons that may underlie a refusal of amputation for 224 people living in Benin, by the approach of the reversal theory. The results show that the fear of losing personal identity, the fear of hospitals and medical staff, the belief that the surgery was unnecessary, a lack of confidence in the competences and dedication of doctors, the fear of losing others esteem and the loss of spiritual strength, are among the main factors motivating a refusal of amputation.

Amputation is the oldest surgical procedure recorded. In small animals, mainly dogs and cats, the goal of these procedures maintain the patient's life, when it is affected by lesions that progress to necrosis, malignancies, distal irreparable injury, and another one. The force platforms used to measure ground reaction forces involved inhuman and animal movement, allowing the interpretation of movement through mechanical variables. This study aims to analyse the distribution of weighting every limb and compare them with data from animals considered normal (with four limbs). It was studied 20 canines, divided into four groups: Group 1 (without the left forelimb), Group 2 (without the right forelimb), Group 3 (without the left hind limb) and Group4 (without the right hind limb). The animals evaluated within groups were not normal standard and they were above or below the upper and lower limits, because they had not one of the four members, adapting and transferring your weight to one of the other three members. It can be concluded that canines without the left forelimb band right forelimb transfer the weight to theirs contra lateral sides. Dogs that have not left forelimb transfer 76.99% of weight to the contra lateral side, as well as dog without right forelimb transferring 71.73% of weight to the contra lateral side. The canines that have not the left or right hind limbs, transfer weight to the forelimbs. / A amputação é o procedimento cirúrgico mais antigo registrado. Em animais de pequeno porte, principalmente cães e gatos, o objetivo desta cirurgia é manter a vida do paciente, quando acometido por lesões que evoluem para necrose, neoplasias malignas, lesões distais irreparáveis, dentre outras causas. A plataforma de força é utilizada para medir as forças de reação do solo envolvidas no movimento humano e animal, possibilitando a interpretação do movimento através de variáveis mecânicas. O presente estudo tem como objetivo analisar a distribuição de força em cada membro e comparar com os dados de animais, considerados normais, por possuírem quatro membros. Para isso, foram utilizados 20 animais, caninos divididos em quatro grupos: o Grupo 1 (sem o membro anterior esquerdo), o Grupo 2 (sem o membro anterior direito), Grupo 3 (sem o membro posterior esquerdo) e o Grupo 4 (sem o membro posterior direito). Todos os animais avaliados não estavam dentro dos padrões considerados normais, ou estavam acima ou abaixo dos limites superiores e inferiores, pois não tinham um dos quatros membros, adaptando-se e transferindo seu peso para os outros três membros. Dessa forma, pode-se concluir que os animais sem o membro anterior esquerdo e o membro anterior direito transferem seu peso para seu lado contralateral. Os cães que não possuem membro anterior esquerdo transferem 76,99% do seu peso para o lado contralateral, e os sem membro anterior direito transferem 71,73% do seu peso para o lado contralateral. O grupo de animais que não possui o membro posterior esquerdo ou direito, transfere seu peso para os membros anteriores.

The purpose of this study was to develop an intuitive software that aids in the field of prosthetic training and rehabilitation by creating an individualized visualization of joint angles. This software is titled “the prosthetic training software (PTS) for individualized joint angle representation”, and it enables the individualized portrayal of predicted or pre-recorded joint angles. The PTS is an intuitive program for clinicians and prosthesis users that produces an animation of a virtual avatar reflecting the user’s segment lengths and amputation for rehabilitation and training purposes. The PTS consists of a graphical user interface (GUI) and a 3D visualization of the information input into the GUI. This software was developed in Microsoft Visual Studio (Microsoft, Redmond, Washington) as well as the Unity game engine (Unity Technologies, San Francisco, California) in the programming language C#. Four GUI tabs were created consisting of a patient input tab, a patient measurements tab, a prosthesis view and search tab, and a tab dedicated to editing a list of prostheses. Code was developed to take information input into these tabs to create an individualized 3D human model for the visualization. Twenty-four models were created in order to allow for unique portrayal of that input data. The models consisted of small, medium and large sizes, both male and female genders, and able-bodied, transradial left side, and transradial right side amputation variations. A generic transradial prosthesis was created for the use in the variations of these models. An additional six stick figure models were generated in order to give additional perspective of the portrayed joint angles. Code was also developed in order to animate these models accurately to the joint angles that are sent to them. Playback speed, viewing orientation, and perspective control functionalities were developed in order to assist in the comprehensiveness of the displayed joint angles. The PTS is not meant to be standalone software, however, the functionalities that it needed to encapsulate in order to work in conjunction with research currently being conducted at USF were tested. The intuitiveness of the GUI and visualization was evaluated by ease of use surveys, as well as volunteer commentary, in order to find how easily the interface that can be operated in a home setting without the oversight of an experienced operator. On average, subjects agreed that the PTS was intuitive to use, both for inputting information and utilizing the visualization. Feedback from these surveys will be used to further improve the PTS in the future. The feasibility of learning from the visualization output from the PTS was tested by comparing motions from five able-bodied subjects before and after having been taught three motions comprising pre-recorded joint angles animated by the PTS. Joint angles were calculated from recorded marker positions. It was found that after viewing the animation, the joint angles were markedly closer to the joint angles portrayed to them. This shows that the PTS is fully capable of showing joint angles in a comprehensive way. Future work will include additional testing of these functionalities, including the testing of prosthesis users, as well as the introduction and testing of new features of prosthesis recommendation and predictive joint angle production when later combined with future research.

Orientador: Sergio Roberto de Lucca / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T07:09:40Z (GMT). No. of bitstreams: 1 Farias_SamanthaHasegawa_M.pdf: 1856773 bytes, checksum: f7b96ea7213453c0adbb4fd4c64e3e06 (MD5) Previous issue date: 2013 / Resumo: É expressivo o número de Pessoas Portadoras de Deficiência (PPD) no Brasil e no mundo. Um dos fatores que levam ao aumento das estatísticas relacionadas a indivíduos com deficiência adquirida é o Acidente de Trabalho (AT), que pode provocar sequela permanente como amputações, comprometendo a qualidade de vida e do trabalho do trabalhador acidentado. Para possibilitar a reinserção dos acidentados no mercado de trabalho, o Instituto Nacional de Seguridade Social (INSS) mantém o Programa de Reabilitação Profissional (PRP). Objetivo: Estudar as características sociodemográficas e profissionais dos trabalhadores amputados, vítimas de AT, que receberam órtese e prótese do setor de Reabilitação Profissional do INSS e verificar as características dos acidentes de trabalho, a taxa de retorno ao mercado de trabalho formal, os fatores de sucesso e insucesso do PRP, discutir a importância da prótese como parte do processo de reinserção profissional. Métodos: O presente trabalho é um estudo transversal, descritivo, quantitativo, realizado INSS de Campinas/SP. A população de estudo foi constituída por todos os amputados inscritos na RP do INSS, no período de 2007 a 2012. Os dados foram coletados através de um levantamento de informações sócio-demográficas contidas nos prontuários dos amputados por acidente de trabalho, tais como: idade, gênero, dados da empresa, situação funcional antes e depois do acidente, utilização de recurso auxiliar para locomoção e participação no programa de reabilitação profissional. Resultados: Foram analisados 40 amputados, sendo 37 do sexo masculino. Nesta população de estudo, os adultos jovens na faixa etária de 18 a 29 anos foram os mais acometidos. O ramo de atividade que mais contribuiu para a ocorrência de AT com amputação foi o de Indústria de transformação com 30% dos casos. Em relação à ocupação dos acidentados, 60% trabalhavam na produção de bens e serviços industriais. Ocorreram 6 casos de AT com desvio de função e 10 acidentes de trajeto. A prótese foi utilizada por 38 indivíduos amputados enquanto que os demais utilizaram órteses como recurso auxiliar de locomoção. Participaram do PRP 28 amputados e, desses, 20 foram reinseridos no mercado de trabalho. Conclusão: Constatou-se que 65% dos trabalhadores protetizados foram reinseridos no mercado de trabalho. Discute-se o papel do atual modelo do PRP, que além do fornecimento de prótese ao trabalhador com sequela permanente não se evidencia o suporte psicossocial para acompanhamento e efetiva reinserção destes trabalhadores / Abstract: It is expressive the number of Persons with Disabilities (PWD) in Brazil and worldwide. One of the factors that leads to the increase of statistics related to acquired deficiency is the Occupational Accident (OA), which can cause permanent sequelae such as amputations, compromising the quality of life and work of the injured worker. To allow the reintegration of the victims into the labor market, the National Institute Of Social Security (INSS) keeps the Professional Rehabilitation Program (PRP). Objective: To study the socio demographic and professional characteristics of the amputees workers, victims of OA, who have received orthoses and prosthesis of the Professional Rehabilitation sector of INSS and verify characteristics of occupational accidents, the rate of return to the formal labor market, the success and failure factors of PRP, to discuss the importance of the prosthesis as part of the professional reintegration process. Methods: The present paper is a cross-sectional, descriptive, quantitative study conducted at the National Institute Of Social Security (INSS) in Campinas, São Paulo. The study population comprised all amputees who participated in the Professional Rehabilitation program in the period from 2007 to 2012. Data were collected through a survey on sociodemographic information contained on patient charts of occupational accident amputees, such as age, gender, company details, position before and after the accident, use of auxiliary device for ambulation and participation in the occupational rehabilitation program. Results: 40 amputees were analyzed, 37 being males. Young adults in the age group from 18 to 29 years were the main victims. The fields of activity that contributed the most to the occurrence of occupational accidents with amputation were trade, manufacturing industry with 30% of cases. Regarding the occupation of the injured, 60% worked in the production of goods and industrial services. Six cases of occupational accident occurred while performing activities not suited to the job, and ten were commuting accidents. Prosthesis was worn by 38 amputees, while the others used orthoses as an auxiliary device for ambulation. Most amputees (28) participated in the Professional Rehabilitation Program, amputees and, of these, 20 were reintegrated into the labor market. Conclusion: A was found that 65% of workers with prostheses were reinserted into the formal labor market. It discusses the role of the current model of PRP that beyond providing permanent prosthesis to the worker with permanent sequel the psychosocial support is not evident for monitoring and effective reintegration of these workers / Mestrado / Epidemiologia / Mestra em Saúde Coletiva

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-05-18T14:21:17Z No. of bitstreams: 1 Mozania Reis de Matos.pdf: 2867660 bytes, checksum: ba235c77e42996f7aa6a0a4de5a2c5cd (MD5) / Made available in DSpace on 2016-05-18T14:21:17Z (GMT). No. of bitstreams: 1 Mozania Reis de Matos.pdf: 2867660 bytes, checksum: ba235c77e42996f7aa6a0a4de5a2c5cd (MD5) Previous issue date: 2015-03-03 / In practical prevention , the instruments that extend self-care are welcome. Added to this the stimulus promotion, health education and the interdisciplinary care. The Patient Interpretation of Neuropaty (PIN), is a questionnaire of Interpretation of neuropathy by patient, developed and validated in the USA and in England (UK). By means of this instrument, the patient makes the self-evaluation of your foot and health care to be carried out with it, aiming at the prevention of ulcer diabetic foot. Thus, the aim of the present study is to translate and validate the questionnaire of interpretation of neuropathy for the Portuguese and assess the degree of understanding of the patients on the questions of (PIN). Participated in this study 100 patients at the outpatient clinic of foot insensitive of the Institute of Orthopedics and Traumatology, University of Sao Paulo. Were used parametric and non-parametric tests in the analysis of data.The values obtainedwith the BrazilianversionPINare verysimilar to the valuesof the original versions, theUSAandtheUK.We think it isa valuabletool providingthe patientobserveneuropathicchangesthat increase the risk of ulcers on the feet. The questionnairetranslated and validatedfor the Portuguese language, soit seemsto be a reliableandapplicabletool to evaluate theself-careof the patientat the same timethat allows thehealthcare professionalto designeffective measuresforprevention ofdiabetic footulcer, resulting in a betterprognosisandquality of life ofdiabetes patientswithND. / Nas práticas de prevenção, os instrumentos que ampliem o autocuidado são bem vindos. Soma-se a isto o estimulo a promoção, a educação em saúde e o atendimento interdisciplinar. O PatientInterpretationofNeuropaty (PIN), é um questionário de Interpretação da Neuropatia pelo Paciente, desenvolvido e validado nos USA e na Inglaterra(UK). Por meio deste instrumento o paciente faz a auto avaliação do seu pé e dos cuidados de saúde a serem realizados com ele, visando à prevenção da úlcera de pé diabético. Sendo assim o presente estudo tem como objetivo traduzir e validar o questionário de interpretação da neuropatia para o português e avaliar o grau de compreensão dos pacientes sobre as indagações do (PIN). Participaram deste estudo 100 pacientes do ambulatório de pé insensível do Instituto de Ortopedia e Traumatologia da Universidade de São Paulo. Foram usados testes paramétricos e não paramétricos na análise de dados. Os valores obtidos com a versão Brasileira do PIN são muito semelhantes aos valores das versões originais, dos USA e da U.K. Julgamos ser um instrumento valioso que propicia ao paciente observar alterações neuropáticas que aumentam o risco de úlcera nos pés. O questionário traduzido e validado para a língua portuguesa, parece assim ser um instrumento confiável e aplicável paraavaliar o autocuidado do paciente,ao mesmo tempo quepermite ao profissional de saúde desenhar medidas efetivas para prevenção da úlcera de pé diabético,ocasionando um melhor prognostico e qualidade de vida dos portadores de diabetes com ND.

Det utförs ca 2 250 amputationer i Sverige årligen, dock är ej amputation av tå eller genom foten inräknat i den siffran. Att genomgå en amputation medför en betydande funktionsnedsättning som inte bara påverkar rörelseförmågan och aktiviteter i det dagliga livet utan även den psykosociala anpassningen, kroppsuppfattning och sociala relationer. Att genomgå amputation är inte smärtfritt och kan komma med kvarvarande smärta i nedre extremiteterna. Syfte: Att beskriva personers upplevelser av det dagliga livet efter att ha genomgått en amputation av nedre extremitet. Metod: En litteraturstudie baserad på 12 vetenskapliga artiklar analyserade utifrån en kvalitativ innehållsanalys med ett inifrån perspektiv och manifest ansats. Resultat: Innehållsanalysen resulterade i fyra slutkategorier; att ha svårt att acceptera att inte kunna leva som tidigare, att känna sig annorlunda och möta svårigheter i vardagen, att vilja vara oberoende men samtidigt vilja få stöd och att det går att leva ett bra liv trots amputation. Slutsats: Resultatet visar vikten av att som vårdpersonal arbeta personcentrerat och att inte glömma bort att stötta även emotionella behov. Den sexuella hälsan efter amputation upplevdes viktig att få prata om men vårdpersonal behöver bli bättre på att lyfta ämnet. Att få möta och prata med andra som också genomgått amputation av nedre extremitet väckte tankar om hinder samt möjligheter och detta upplevdes stöttande och uppmuntrande.

Bakgrund: Att genomgå en amputation är en livsomvälvande händelse som bjuder på utmaningar både fysiskt och psykiskt för den drabbade personen inte minst efter utskrivning från sjukhus. Syfte: Syftet med den här litteraturstudien var att sammanställa tidigare kvalitativ forskning om patienters erfarenheter av rehabilitering efter amputation av nedre extremitet efter utskrivning från sjukhus. Metod: Scoping review. Resultat: Resultatet av den här studien byggde på tolv artiklar och fem huvudteman identifierades samt femton subteman. Studien visade bland annat på hur informationsbrist råder från sjukvårdspersonalen till patienten på olika nivåer och att tilliten till personalen är viktig. Bristande ekonomi minskade följsamheten till rehabiliteringen av olika anledningar, men har även en direkt korrelation till patientens överlevnad. Kostnaden för sjukvården beskrevs även som en fråga om liv och död där fri sjukvård var avgörande för socioekonomiskt utsatta grupper. Konklusion: Konklusionen belyste att partner och familj är viktiga för hur patienten tacklar själva rehabiliteringsprocessen. Därför är det viktigt att sjuksköterskan är lyhörd vid vårdövergång från sjukhus till hemmiljö eftersom vårdbördan för familjen ökar och patienten är som mest sårbar. / Background: Going through an amputation is a life-changing event followed by challenges physically and mentally for the affected person not least after discharge from hospital. Aim: The aim of this literature review was to compile previous qualitative research of patients’ experience of rehabilitation after amputation of lower extremity after discharge from hospital. Method: Scoping review. Result: Based on twelve scientific articles five main themes and fifteen subthemes were identified. This study illustrated how lack of information exists from healthcare professionals to the patient on different levels and trust towards the staff is important. Lack of financial resources reduced the adherence to rehabilitation and had a direct correlation to patient survival. The cost of medical care was described as a matter of life and death where free health care was crucial for socio-economically vulnerable groups. Conclusion: The conclusion illuminated the importance of the partner and family for how the patient deal with the rehabilitation process. It is important that the nurse is responsive when care transition occurs from hospital to home environment as the burden of care for the family increases and the patient is the most vulnerable.

This thesis elaborates on design and fabrication of an artificial mechanical upper limb prototype for transradial amputations, i. e. for patients with stump between elbow and wrist joints. The artificial limb is designed for use in a wide spectrum of patients. Therefore, the main components are designed to be applicable to smaller as well as larger hand dimensions. The artificial mechanical limb is designed to be controlled by the other hand of a patient and enables grasping of objects via cylindrical and hook grip. Fingers are driven by tension springs and can be locked in extension. Clenching can be initiated by pressing a button, which unlocks the fingers, thus an object can be grasped. Wrist joint is adjustable when pressed a release button. Forearm joint is locked by preloaded spring. The lock of the forearm joint is released by sufficient torque. New position of the forearm joint is locked automatically when the torque is not being applied. Prototypes of the artificial mechanical upper limb were manufactured by using of rapid prototyping technologies (FDM, SLM) as well as CNC milling machine. All parts of the artificial limb were designed with regard to manufacturability by conventional methods such as casting, injection and the like. The artificial limb prototype had been designed on 3D data basis of a specific patient, who already has tested the prototype. Following materials were used on the prototype: ABS plastic, SikaBlock M940 polyurethane, aluminium and 316L stainless steel.