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]

Thesis (M.S.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 20 pages. Includes bibliographical references.

Made available in DSpace on 2015-07-22T20:49:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-11-24 / Objetivo: avaliar pessoas com amputações de membros inferiores e descrever as variáveis sociodemográficas e clínicas, além de identificar quais dessas influenciam a qualidade de vida e alterações psíquicas. Métodos: estudo transversal, que incluiu pessoas submetidas a amputações de membros inferiores em todos os níveis e etiologias, sendo excluídas as que apresentaram idade inferior a 14 anos. Foram utilizados os questionários SF-36 e SRQ-20 para avaliar a qualidade de vida e as alterações psíquicas respectivamente em relação a variáveis sociodemográficas e clínicas. Resultados: foram entrevistadas 138 pessoas, com idade média de 62 anos, baixa renda e escolaridade, o SF-36 mostrou que apenas as que não eram casadas apresentaram escores médios de várias dimensões significantemente maiores e a avaliação das condições psíquicas foram influenciadas pelo gênero feminino, não ser casado, não ser independente, tempo de amputação e número de doenças associadas, porém depois da regressão logística, apenas o número de doenças associadas e independência mostraram-se significativas. Conclusões: as alterações na qualidade de vida estiveram associadas à presença de condições mórbidas e ao fato de ter um companheiro; 43% dos pacientes apresentaram doença psíquica, que estiveram associadas com o número de doenças crônicas e o fato de não serem independentes; além disso, foram excluídos do mercado de trabalho, não foram reabilitados. / Objective: To evaluate people with lower limb amputations in community base and describe the demographic and clinical variables, and identify which of these influence the quality of life and psychological disorders. Methods: A cross-sectional study that included people who undergone amputation at all levels and etiologies; were excluded younger than 14 years. Was used the SF-36 and SRQ-20 to assess quality of life and the psychological changes respectively in relation to demographic, social and clinical variables. Results: 138 low income and education people was interviewed; the SF-36 showed that only those who were not married had average scores significantly higher in several dimensions and assessment of psychological conditions were influenced by women, not being married, not independent, time of amputation, and number of associated diseases, but after logistic regression, only the number of associated diseases and independence were significant. Conclusions: changes in quality of life were associated with the presence of morbid conditions and to having a partner, 43% of patients had mental illness that were associated with the number of chronic diseases and that they were not independent and, moreover, ware excluded labor market and ware not being rehabilitated. / TEDE / BV UNIFESP: Teses e dissertações

Peripheral arterial disease (PAD) is a disease which may cause gradual narrowing and possibly congestion of arteries that are responsible for nourishing the lower limbs. Most often this condition develops consequently with atherosclerosis. The most advanced stage of PAD is called critical limb ischemia. The changes induced by atherosclerosis affect not only the lower limb arteries, but at the time of the diagnosis of PAD all arteries in the body are already affected. Therefore PAD belongs among cardiovascular diseases and its diagnosis is a negative prognostic factor of the overall cardiovascular risk. The aim of treatment interventions is to reduce complications that accompany this ailment and their impact on the patient's life. The aim of the thesis was to find out to what extend the patients are informed about the causes of PAD, options of its treatment and the impact of prevention and life style on the overall prognosis of the disease. The first objective of the thesis is to find out if patients are aware of the risks of PAD treatment, one of which is leg amputation. The second objective is to find out whether the patients are sufficiently informed about their condition. The third objective is to evaluate whether patients follow the prescribed treatment. The fourth objective is to find out whether patients are willing to change their life style in order to eliminate the risk of lower limb amputation. A part of interviews with patients was to educate them about their condition, the necessity of following the treatment regimen and the impact of lifestyle on the affected leg prognosis. At the end, the interviewed received educational handouts with information about the most important suggested procedures to follow. The practical part of the thesis is based on qualitative research. The data was collected in semi-structured interviews. The interviews were conducted in two steps. The first step was to educate patients about PAD and distribute informational handouts. The second round of interviews took place intentionally several months after the first ones. Their purpose was to assess the impact of education on patients' compliance with treatment and regimen. The research shows the majority of the interviewed were well-informed about the crucial aspects of their condition and treatment procedures. The participants understood the given information and considered it satisfactory. However, it was surprising that patients had not looked for information themselves. Simultaneously, it was ascertained that most of the respondents were aware of the prognosis and risks related to the treatment. The two-step interviews showed some respondents were not aware of the causes of their disease. It can be therefore assumed that their ignorance of the risk factors and their impact on the development of the disease is the reason why patients do not give enough importance to the suggested treatment regimen. Furthermore, it was found out that they had not look for a substitute solution if they are not able to follow the recommended treatment regimen. The results of this thesis show that although the elimination of the risk factors is crucial for patients' future they do not pay enough attention to them. There are two aspects to it; either patients trivialize the potential risks or are apathetic or are not sufficiently informed. It is hard to have some impact on patients' apathy and trivialization of their condition. Nevertheless, it is possible to influence the second aspect, which is the subject of the final part of the thesis and the educational handout. As was discovered during the interviews, the information provided by doctors during ambulatory treatment is not thorough and does not include practical advice how to follow treatment regimen. Patients should be informed by nurse either personally or during the sessions. In this way the patient should be also selfmotivated in their treatment.

This thesis named: "Problems of usage of prosthetic aids for children" focuses on the nursing care specifics of the child patient after an amputation. The Amputation is defined as removal of the peripheral portion of the body with an interruption of a bone and the soft tissues which allows subsequent prosthetic solution. Prosthesis is externally applied aid, which replace missing or underdeveloped part of a limb eventually the whole limb. The aim of the Prosthetic centers is to offer to its clients the exact prosthetic solution which could fully replace the function of a missing limb and allow the child to live full life without any limitations. The intention of the thesis was to summarize the problematic of the upper and lower limbs amputation into one publication and also to focus this thesis on children and prosthetic aids for them. The reason is that in Czech literature there is no complex information which focuses on specifics for children. The list of synoptic distribution of the types of prosthetic aids was created based on the level of amputation. A large part of this thesis deals with the nursing care, including rehabilitation after amputation and prosthetic solutions. The possibility of the children´s active life with prosthetic aids was mentioned, also how they coped with the loss of a limb. And then the specifics of the nursing care and the attitude of the nursing staff to children and their parents were mentioned too. In the research part of the thesis three aims were set: Find out the limitations or the changes in the family´s life style which has child with prosthesis and the limitations in child´s active life with prosthesis. Ascertain the specifics and the lacks of the nursing care during preparation of children for the prosthetic aid. Based on these following aims the research questions were set: How was the life style of the family with child with prosthetic aid affected? What are the limitations in child´s active life with prosthesis? What are the specifics of the nursing care during preparation of the child for the prosthetic aid? The empirical part of my thesis was processed with qualitative data analysis using technique of the unstructured in-depth interviews. The first research group consisted of seven respondents. Five out of them were parents of the children without the limb and two out of them were children without the limb itself, who were old enough to give us the trustworthy information. The information from the prosthetic technicians was followed with these interviews. The prosthetic technicians clarified us the questions which resulted from reaching the respondents who cannot have all theoretical knowledge regarding the issue. We hope that the results from this thesis will be benefit not only for the medical staff to improve the quality of the nursing care, but also for the respondents who can find the information which was missing till this time.

Orientadora: Profa. Dra. Léia Bernardi Bagesteiro / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Neurociência e Cognição, 2014. / A maioria das amputações traumáticas do membro superior ocorre em níveis do punho e da mão. O uso de sinais bioelétricos, como os capturados pela eletromiografia de músculos residuais no segmento mão-braço amputado, já é uma realidade, porém as taxas de rejeição das próteses mioelétricas ainda são elevadas. Um dos maiores desafios atuais é melhorar o desempenho das próteses robóticas a fim de que a interface homem-máquina seja o mais natural possível. O presente estudo teve por objetivo avaliar a intensidade elétrica dos músculos residuais do coto durante movimentos do segmento mão-braço de indivíduos amputados de membro superior. Foram caracterizados diferentes movimentos-alvo a fim de auxiliar no conhecimento da ação muscular após amputação. Oito canais de eletromiografia foram posicionados no membro superior e coto: quatro no braço e quatro no antebraço. Nove movimentos-alvo contínuos foram realizados duas vezes em cada uma das duas séries de movimentos avaliadas. Foram analisados o coto (grupo experimental membro amputado), o membro contralateral à amputação (grupo experimental membro não amputado) e um grupo controle. Todos os grupos apresentaram as mesmas etapas de coleta, desde o posicionamento dos eletrodos até a análise do sinal eletromiográfico. Os dados foram comparados para maior compreensão dos movimentos do membro superior nesses grupos. Os resultados apresentaram diferença entre os grupos. A musculatura de braço teve maior intensidade de ativação elétrica no grupo controle. Por sua vez, o grupo experimental membro amputado teve maior intensidade de ativação em musculaturas extensoras e maior diferenciação dos canais do antebraço. Contudo, o grupo experimental membro não amputado foi o que mais se diferenciou nas diferentes análises, sendo observado menor intensidade de ativação elétrica no braço e antebraço. Conclui-se que a intensidade de ativação dos músculos residuais do coto difere do membro não amputado. / Most traumatic upper-limb amputations occur at the wrist and hand levels. Bioelectric signals, such as the ones captured by electromyography at the amputated hand-arm segment are already a reality, yet rejection rates of myoelectric prostheses are still high. The main challenge is to improve the performance of robotic prostheses enabling a more natural man-machine interface. This study evaluated the electrical magnitude of residual muscles during hand-arm movements of upper limb amputee. Different movements were chosen to promote muscle activation knowledge after amputation. Eight electromyography channels were positioned on the upper-limb and stump: four at the upper arm and four at the forearm. Nine continuous movements were performed twice on each of the two series evaluated. Three groups were analyzed: amputee group (experimental group: amputated limb), contralateral limb amputation (experimental group: non-amputated limb) and control group. All groups had the same data collection phases, electrodes positioning and eletromyographic signals analysis. Data were compared for better understanding of upper limb movements. The results showed difference between groups. The upper arm muscles had greater magnitude of electrical activation in the control group. The experimental group: amputated limb had greater magnitude of electrical activation in the extensor musculature and greater difference from the forearm channels. Moreover the experimental group: non-amputated limb was the most distinguished in comparison with the other two groups on different analyzes, with lower magnitude of electrical activation observed in the upper arm and forearm. It is concluded that the magnitude of activation of the residual muscles in the amputated limb differs from non-amputated limb.

Made available in DSpace on 2014-06-11T19:28:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-03Bitstream added on 2014-06-13T18:57:12Z : No. of bitstreams: 1 oliveira_jz_me_botfm.pdf: 1081861 bytes, checksum: 92c0e3a4a446049c9479176e65569d5f (MD5) / Fundação Pio Xii - Barretos / O aumento considerável de pessoas no mundo acometidas por câncer, associado ao prolongamento da vida, em decorrência das avançadas tecnologias utilizadas no tratamento, reforça a importância de se utilizar a qualidade de vida como uma medida importante dos tratamentos realizados. Para os pacientes com câncer de reto, com tumores muito próximos aos esfíncteres anais ou envolvendo essas estruturas, a amputação abdominoperineal do reto continua sendo o principal tratamento. Como alternativa à colostomia abdominal para pacientes selecionados, a colostomia perineal, segundo a técnica de Alcino Lázaro, tem sido empregada com resultados satisfatórios. No entanto, esses pacientes terão que realizar a auto irrigação para o resto da vida, garantindo a continência intestinal. Assim, o objetivo deste estudo foi avaliar as complicações cirúrgicas e a qualidade de vida dos pacientes submetidos à amputação abdominoperineal do reto com colostomia abdominal, ou com colostomia perineal que se auto irrigam, seguindo um novo método de irrigação e avaliar a eficácia desse novo método. Foi realizado um estudo transversal, após aprovação do Comitê de Ética em Pesquisa do Hospital do Câncer de Barretos, entre junho de 2009 a novembro de 2009. A qualidade de vida foi avaliada utilizando dois questionários desenvolvidos pela European Organization for Research and Treatment of Câncer (EORTC), sendo um específico para câncer (EORTC QLQ-C30) e outro específico para câncer de reto (EORTC QLQ-CR38). Um total de 38 pacientes foram incluídos, sendo 21 com colostomia perineal e 17 com colostomia abdominal. Em relação às características sócio demográficas, clínicas e terapêuticas, os grupos foram semelhantes no que diz respeito à idade, sexo, cor, estado civil, escolaridade, renda, ocupação, estádio clínico,... / The considerable increase of people in the world suffer from cancer, associated with prolongation of the life in result of the advanced technologies used in the treatment, reinforces the importance of using quality of life as an important measure of the carried through treatments. For patients with rectal cancer, with tumors very close to the anal sphincter or involving these structures, amputation abdominoperineal of the rectum continues being the main treatment. As an alternative to abdominal colostomy for selected patients, a perineal colostomy, using the technique of Alcino Lázaro, has been used with satisfactory results. However, these patients will have to perform self-irrigation for the rest of your life, guaranteed bowel continence. The aim of this study to evaluate the surgical complications and the quality of life of patients who underwent the abdominoperineal amputation of the rectum and either had an abdominal colostomy or a perineal colostomy and self-irrigation through a new method of irrigation and evaluate the effectiveness of this new method. After official approval from the Ethics Committee in Research of the Cancer Hospital of Barretos, Brazil, a cross-sectional study with prospective data collection of 38 patients was carried out from June 2009 to November 2009. The quality of life was evaluated through two questionnaires developed by the European Organization for Research and Treatment of Cancer (EORTC): one was specific for cancer (EORTC QLQ-C30) and the other one was specific for rectal cancer (EORTC QLQ-CR38). A total of 38 patients were included, 21 with perineal colostomy and 17 with abdominal colostomy. Regarding socio-demographic, clinical and therapeutic characteristics, the groups were similar in age, gender, race, marital status, education, income, occupation, clinical... (Complete abstract click electronic access below)

Submitted by Caroline Periotto (carol@ufscar.br) on 2016-09-21T15:12:29Z No. of bitstreams: 1 TeseELO.pdf: 1726425 bytes, checksum: 91c6597cb879cd38528c72c96971b537 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-23T18:28:07Z (GMT) No. of bitstreams: 1 TeseELO.pdf: 1726425 bytes, checksum: 91c6597cb879cd38528c72c96971b537 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-23T18:28:16Z (GMT) No. of bitstreams: 1 TeseELO.pdf: 1726425 bytes, checksum: 91c6597cb879cd38528c72c96971b537 (MD5) / Made available in DSpace on 2016-09-23T18:28:24Z (GMT). No. of bitstreams: 1 TeseELO.pdf: 1726425 bytes, checksum: 91c6597cb879cd38528c72c96971b537 (MD5) Previous issue date: 2016-03-31 / Não recebi financiamento / In this study we aimed to investigate, beside people with physical disabilities, how they express their sexuality from their life stories and their impairment/disabled bodies. The Life History, being defined as one of the theoretical contributions, made it possible to establish a channel through which disabled people could relive facts, experiences and events related to sexuality, identifying ways, glances, pleasures and printed sensibilities through injured, amputated and disabled bodies. Other theoretical contributions, from the anthropological social field, especially the critical studies of disability (Disability Studies), substantiated the ways and debates in the intersection with the sexuality field. Hence, we defined the Collective Subject Discourse (DSC) as the study method, especially to encompass analysis techniques that allow gathering ideas, senses and thoughts of the same social group, projecting a single collective discourse in the light of various themes. The sample was composed of three people with physical disabilities, heterosexual men, members of an institution that provides services to people with disabilities, in a city in the interior of São Paulo state. Data collection took place through open interviews (recorded audio), without pre-established scripts and have been developed until to reach a saturation point (exhaust affairs). The meetings took place without delimitation of time or amount, varying according each participant. All interviews were transcribed, and the analysis took place based on techniques used in DSC, using their methodological approaches. The composition of the DSC enabled understanding the sexuality of people with physical disabilities as it is still regulated by policy and biomedical processes, which make pathological not only people with disabilities, but anyone who shows attraction, erotic and sexual desire by people with injured, amputated or disabled bodies. There is an urgent need to admit new aesthetic, sexual and political horizons for the physically disability, projecting the injured, amputated and disabled body as beautiful, desirable, sexy, attractive and, undeniably, delicious. Only from that aesthetic reconfiguration of disability, each and every disabled person will be accepted as a sexual and sexualized person. / A presente pesquisa objetivou investigar, junto às pessoas com deficiência física, como elas expressam sua sexualidade a partir de suas históricas de vida e seus corpos lesionados/deficientes. A História de Vida, ao ser definida como um dos aportes teóricos, possibilitou estabelecer um canal por meio do qual as pessoas com deficiências físicas puderam reviver fatos, experiências e acontecimentos ligados à sexualidade, identificando caminhos, olhares, prazeres e sensibilidades impressas por meio dos corpos lesionados, amputados e deficientes. Outros contributos teóricos oriundos do campo sócio antropológico, especialmente os estudos críticos da deficiência (Disability Studies), consubstanciaram os caminhos e debates na intersecção com o campo da sexualidade. Diante do exposto, definiu-se o Discurso do Sujeito Coletivo (DSC) como o método da pesquisa, especialmente por englobar técnicas de análise que permitem amalgamar ideias, sentidos e pensamentos de um mesmo grupo social, projetando-se um único discurso coletivo em face de variadas temáticas. A amostra foi composta por três pessoas com deficiência física, ambos homens heterossexuais, integrantes de uma instituição que presta atendimento às pessoas com deficiência em um município do interior do estado de São Paulo. A coleta de dados aconteceu por meio de entrevistas abertas (gravadas em áudio), sem roteiros preestabelecidos, e foram desenvolvidas até atingirem um ponto de saturação (esgotar os assuntos). Os encontros aconteceram sem delimitação de tempo ou quantidade, variando para cada participante. Todas as entrevistas foram transcritas e as análises aconteceram com base nas técnicas empregadas no DSC, recorrendo-se às suas figuras metodológicas. A análise da composição dos DSC permitiu vislumbrar que a sexualidade de pessoas com deficiências físicas ainda é regulada por processos normativos e biomédicos, que as patologizam, bem como qualquer pessoa que demonstre atração, desejo erótico e sexual por pessoas com corpos lesionados/amputados/deficientes. Assim, urge a necessidade de admitir novos horizontes estéticos, sexuais e políticos para a deficiência física, projetando-se o corpo lesionado, amputado e deficiente como belo, desejável, sexy, atraente e, indiscutivelmente, delicioso. Somente a partir desse reconfiguração estética da deficiência admitir-se-á toda e qualquer pessoa com deficiência uma pessoa sexual e sexualizada.

Made available in DSpace on 2016-12-12T17:32:57Z (GMT). No. of bitstreams: 1 RESUMO- Eradio.pdf: 67154 bytes, checksum: 3d6ece6b7ed04b062675546adadf2569 (MD5) Previous issue date: 2015-07-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The lower limb amputation involves important motor, psychological and social sequelae, being a serious public health problem in Brazil and worldwide. Identify the major barriers and facilitators involved in the person s rehabilitation process with amputated lower limb in Florianópolis were the main objective of this study. Look at the amputee person in the context of functionality enlarges the horizon and contextualizes the individual, the family, the community in the biopsychosocial perspective. Therefore it attempted to describe the functionality and disability process through ICF and know the issues related to assistance and therapeutic itineraries experience. This is an exploratory and descriptive research with qualitative approach, with production data purchased through semi-structured interviews, in depth, complemented by a field diary with six individuals who experienced amputation of lower limbs. The data were organized and processed by means of coding, classification and categorization, following the Analysis of Content technique suggested by Bardin. Observing the therapeutic itinerary of the interviewees are perceived access barriers, structural and organizational imposed by the health services and social security. It also was evidenced, the unpreparedness scientific-technical of health professionals, the barriers related to physical accessibility and the lack of medical transports for treatment. During the interviews, the social support, especially the provided by family members and friends were highlighted as an important facilitator. The trajectories also served to highlight the importance of prosthetic for rehabilitation of person amputee as well as the barriers faced to your assurance through Brazilian health system or Social Security. / A amputação de membros inferiores envolve sequelas motoras, psicológicas e sociais importantes, sendo um grave problema de saúde pública no Brasil e no mundo. Identificar as principais barreiras e os facilitadores envolvidos no processo de reabilitação da pessoa amputada de membro inferior no município de Florianópolis foi o principal objetivo deste estudo. Olhar a pessoa amputada no contexto da funcionalidade amplia os horizontes e contextualiza o indivíduo, a família, a comunidade em uma perspectiva biopsicossocial. Para tanto se buscou descrever o processo de funcionalidade e de incapacidade por meio da CIF e conhecer as questões relacionadas à assistência e aos itinerários terapêuticos vivenciados. Trata-se de uma pesquisa exploratória e descritiva com abordagem qualitativa, com produção de dados adquiridos por meio de entrevistas semiestruturadas, em profundidade, complementadas por um diário de campo, com seis indivíduos que sofreram amputação de membros inferiores. Os dados foram organizados e tratados por meio de codificação, classificação e categorização, seguindo a técnica de Análise de Conteúdo sugerida por Bardin. Observando o itinerário terapêutico dos entrevistados perceberam-se barreiras de acesso, estruturais e organizacionais impostas pelos serviços de saúde e previdência social. Ficou evidenciado, também, o despreparo técnico-científico dos profissionais de saúde, as barreiras ligadas à acessibilidade física e a falta de transporte sanitário para tratamento. Durante as entrevistas, o suporte social, sobretudo aquele oferecido pelos familiares e amigos foram ressaltados como importante facilitador. As trajetórias também serviram para destacar a importância da prótese para reabilitação da pessoa amputada, bem como as barreiras enfrentadas para sua garantia por meio do SUS ou Previdência Social.

Este trabalho surgiu a partir da experiência como psicóloga do Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da faculdade de Medicina da Universidade de São Paulo. Mais especificamente ao longo dos anos trabalhando no Grupo de Prótese e Órteses, com pessoas que sofreram amputação de um ou mais membros. A perda de uma parte do corpo implica alterações significativas na vida de um indivíduo, sendo que as amputações decorrentes de acidentes em geral têm a característica de serem súbitas e imprevisíveis, ocasionando mudanças bruscas para as quais não existe preparo possível. A principal questão que norteou este trabalho diz respeito às conseqüências psíquicas que uma perda física pode ocasionar. Procurou-se compreender de que forma, diante de uma ruptura no corpo, há uma interferência na organização psíquica e na maneira pela qual o indivíduo percebe o mundo e se percebe nele; isso, durante o período de reabilitação. Buscou-se refletir sobre um momento de perda da integridade corporal e seus reflexos na unidade psicossomática, a partir de casos clínicos, tendo como referência a psicanálise winnicottiana. Dessa forma, levou-se em conta o percurso do desenvolvimento emocional segundo a teoria do amadurecimento pessoal de D.W.Winnicott para se refletir acerca da possível relação existente entre o estágio alcançado nas tarefas próprias do desenvolvimento normal pelo indivíduo e as conseqüências em termos da continuidade ou não do processo de amadurecimento após a amputação. Para esta investigação utilizou-se o método clínico e o referencial psicanalítico, sendo que para a análise da questão proposta neste trabalho foram apresentados quatro casos clínicos. A perda de uma parte do corpo ocasionou mudanças em todos os indivíduos que fizeram parte deste estudo. Mudou o corpo, a forma de se locomover, o trabalho, o sustento pessoal e familiar, o contato social. Porém a maneira por meio da qual cada um percebeu, significou e vivenciou essa perda e essas mudanças não foi equivalente nem determinada pela qualidade da perda. Assim, concluímos que as conseqüências psíquicas de uma perda física serão aquelas relativas às condições que cada indivíduo tem de elaborar imaginativamente essa perda e transformá-la em vivência, experiência, história pessoal e interpessoal. A articulação da teoria com a análise e discussão do material clínico permitiu perceber que não é possível caracterizar uma clínica dos amputados. Isso porque o que temos são tantas clínicas quanto nos for possível conhecer os indivíduos amputados em seu processo de amadurecimento pessoal anteriormente à amputação. Ou seja, uma amputação não direciona incondicionalmente o modo de um indivíduo estar no mundo, mas implica alterações significativas em sua existência, o que remete à necessidade de reformulações em sua identidade para incluir essa nova dimensão de experiência. A dificuldade em realizar a elaboração imaginativa dessa perda, pode tornar a amputação um acontecimento não integrado na vida de uma pessoa, com conseqüências prejudiciais à sua saúde e ao seu desenvolvimento. / This work arose from the experience as a psychologist in the Institute of Orthopedist and Traumatology of the Hospital das Clinicas of the faculty of Medicine of the University of São Paulo. More specifically along the years working on the Group of Prothesis and Orthesis, with people that suffered amputation of one or more members. The loss of a part of the body involves significant changes in the life of a person. The amputations originated from accidents in general have a characteristic of being sudden and unpredictable causing abrupt alterations in which no preparation is made possible. The main subject which directed this work concerns the psychic consequences that a physical loss causes. We intend to understand in what way, from a rupture of the body, there is the interference of the psychic organization and in what way the person notices the world and perceives himself in it; this, during the period of rehabilitation. We wanted to reflect about the moment of the loss of the integrity of the body and its reflexes on the psychosomatic unit, from clinical cases, with the theoretical reference of maturing of D. W. Winnicott. In this way, we took into account the course of the emotional development according to the theory of personal maturing to reflect about the possible relation existing between the stages reached on the proper tasks of the normal development of the person and the consequences in terms of continuity or not of the process of maturing after the amputation. For this investigation we used the clinical method and the psychoanalysis reference. For the analysis of the subject proposed in this work we presented four clinical cases. The loss of a part of the body caused changes in all of the persons which were part of this study. Changed the body, the way to move, the job, the personal and family maintenance, the social contact. In the other hand the way through which each one perceives, signifies and lives this loss and these changes was not equivalent nor determined by the quality of the loss. This way, we conclude that the psychic consequences of a physical loss are those related to the conditions that each person has to elaborate imaginatively the loss and transform it in a way of life, experience, personal and interpersonal story. The articulation of the theory with the analysis and discussion of the clinical material permitted to notice that it is not possible to characterize a clinic of the amputated. This because what we have are as many clinics as we are able to know the amputated persons in their process of personal maturing previous to the amputation. Or else, an amputation does not direct unconditionally the way that a person exists in the world, but implies in significant alteration of his existence, what refers to a need of reformulations in his identity to include this new dimension of experience. The difficulty in accomplishing the imaginative elaboration of this loss, can transform the amputation in a non integrated occurence in the life of a person, with bad consequences to his health and to his development.