Following lower-limb amputation, patients suffer from sensory loss within the prosthesis/residuum complex leading to diminished proprioception and balance. Artificial sensory systems have the potential to improve rehabilitation outcomes including better functional usage of lower-limb prostheses to achieve a higher quality of life for the prosthetic users. The purpose of this work was to develop and test the e fficacy of a vibrotactile feedback system for lower-limb amputees that may augment feedback during complex balance and movement tasks. Responses to different vibrotactile stimuli frequencies, locations, and physical conditions were assessed. Key outcome measures for this work were the response time and response accuracy of the subjects to the different stimulator configurations. Frequencies closer to 250 Hz applied to the anterior portion of the thigh resulted in the quickest reaction times. When multitasking, reaction times increased. These preliminary results indicate that vibrotactile sensory feedback may be viable to use by lower-limb amputees.

Background: Lower limb amputees face many challenges, and most of them prefer to use prosthetics for daily tasks and activities. The prosthesis is usually a combination of connected prosthetic components, and their spatial orientation is called the prosthetic alignment. Proper alignment is essential, as it substantially affects the quality and comfort of a prosthesis.   Objective: The aim of this study was to create a method that could accurately and effectively quantify the alignment of a transtibial and transfemoral prostheses using Vicon optical motion capture system.   Methods: Two experimental series were conducted. The first one was to test the repeatability of the measurement. Three analysts placed retroreflective markers on the prostheses three times, and five measurements were recorded each time. Alignment parameters were calculated in Vicon ProCalc for each measurement, and a standard error of measurement was found for each alignment parameter. The standard error of measurement was calculated from three variance components, between-analyst, within-analyst, and between-trial variability. The second experimental series was conducted to understand the relationship between alignment adjustments and the outcome parameters. The socket height, internal rotation, flexion, adduction, and translation were modified and measured. The socket translation was calculated in three coordinate systems to study how they affect the outcome.   Results: For the first experimental series, the standard error of measurement for every alignment parameter was below 3° and 6 mm. The between-analyst variability was the most prominent, and the parameters calculated in the sagittal plane were more reliable than those calculated in the frontal and transverse plane. In the second experimental series, there was a linear relationship between the modifications and the measured outcome. When a connection between two prosthetic components was changed by turning the screws one round, the average change in angle between them was 2°, and the average translation change was 4.4 mm. Of the three coordinate systems, the translation calculated in ankle coordinates was more reliable than in global coordinates and describe the translation more effectively than in socket coordinates.   Conclusion: The reliability of the measurements was considered good. The standard error of measurement was low, and the main variability resulted from differences in marker placement between the analysts. The results from the measured alignment changes were as expected. All the parameters could be effectively interpreted, and the ankle coordinates were considered advantageous in describing the socket translation.

Background Recent conflicts have seen an increase in trauma related military amputees who incur complex injuries which result in varied residual limbs. In many cases these amputees have been provided with state of the art (SOTA) components with the expectation that they will transfer into NHS care after military discharge. However, there is a lack of knowledge around how prosthetic prescriptions are made in both the MOD and NHS, including patient involvement. It is important to explore prosthetic prescription decisions to enhance the quality, consistency and equity of care delivery for trauma amputees. This thesis explores decision making in prosthetic care for trauma amputees in the UK during this period of change. Aims To explore aspects of prosthetic care provision in the UK including clinical decision making, patient experience and the transition of prosthetic care from the MOD to the NHS. Design An exploratory qualitative project informed by decision making and patient involvement theory. Semi-structured interviews were carried out with nineteen clinical staff involved in prosthetic provision, six civilian and five veteran trauma amputees. Thematic analysis was used to analyse the data. Findings Prosthetists used a wide range of factors in making prescription decisions, including physical characteristics, patients’ goals, and predicted activity levels. Prescription decision making varied depending on the prosthetists’ level of experience and the different ‘cues’ identified. In some cases there was a lack of transparency about drivers for the prescription choice. Prescription decisions are influenced by long term relationships between prosthetist and patient, allowing a trial and error approach with increasing patient involvement over time. Patient experiences of their trauma amputation influenced their approach to rehabilitation. Patients reported wanting different levels of involvement in their prosthetic care, however, communication was essential for all. Veteran amputees benefited from peer support opportunities which NHS services were less conducive to. However, NHS amputees were more likely to have been ‘involved’ in care decisions. The expectations that MOD patients had of inferior care in the NHS were not realised in the majority of veteran cases. Recommendations Research is needed to support prosthetists’ decisions to become more consistent and transparent. The NHS should consider introducing a peer support model for trauma patients, and particularly in the early stages of rehabilitation.

Thesis (MScMedSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Lower limb amputations cause multiple physical, psychological, environmental and socioeconomic barriers. Individuals who have suffered a lower limb amputation require comprehensive rehabilitation to ensure social integration and economic self-sufficiency. In addition, constant monitoring and evaluation is an essential part of human service delivery programmes. However, the amputation rehabilitation programme offered at Elangeni an outpatient rehabilitation centre for clients with physical disabilities in Paarl, Western Cape, South Africa is not monitored, and has not been evaluated since its inception in 2000. Thus, the current study evolved to describe and evaluate the rehabilitation programme for persons with lower limb amputations at Elangeni. A mixed method descriptive design was implemented. All persons who received rehabilitation, after a major lower limb amputation at Elangeni, between 2000 to 2011, were included in the study population. In addition, the physiotherapist and occupational therapist that provided amputation rehabilitation at Elangeni, at the time of the study, were interviewed. Thirty participants who met the study inclusion criteria were identified. Quantitative data was collected using a researcher designed, structured demographic questionnaire, an International Classification of Function checklist based questionnaire and a participant rehabilitation folder audit form. Two interview schedules one for clients and one for therapists were used for guidance during semi structured interviews. Quantitative data was entered onto a spread sheet and analysed by a statistician using Statistica, version 8. Qualitative data was thematically analysed according to predetermined themes. No programme vision, mission or objectives could be identified for the amputation rehabilitation programme. Poor record keeping practices and a lack of statistics were found. Rehabilitation was impairment focused with no attention given to social integration. Clients who received prosthetic rehabilitation showed improved functional ability with regard to picking up objects from the floor (p = 0.031) getting up from the floor (p = 0.00069), getting out of the house (p = 0.023), going up and down stairs with a handrail (p = 0.037) and moving around in the yard (p = 0.0069), climbing stairs without a handrail (p = 0.037), going up and down a kerb (p = 0.0082) walking or propelling a wheelchair more than 1km (0.0089) and walking in inclement weather (0.017). A lack of indoor mobility training had a statistically significant negative impact on the participants’ ability to lift and carry objects (p 0.011), standing up from sitting (p = 0.042), getting around inside the house (p = 0.00023), picking up objects from the floor (p = 0.00068), getting up from the floor (p = 0.0072), getting out of the house (p = 0.0016), going up and down stairs with a handrail (p = 0.019), moving around in the yard (0.0013), going up and down stairs with-out a hand-rail (p = 0.019), getting up and down a kerb (p = 0.0022), walking or wheeling 1km or more (p = 0.0032) and using transport (p = 0.0034). Failure to address community mobility during rehabilitation had a statistically significant negative impact on all aspects of community mobility scores except doing transfers and driving. In conclusion, for the study participants, Elangeni failed to provide rehabilitation according to the social model of disability and Community Based Rehabilitation principles. It is recommended that managers, service providers, and clients re-consider the purpose of Elangeni and develop a vision and objectives for that service. In addition, management should take an active role in service monitoring and evaluation and provide guidance and mentorship to therapists. / AFRIKAANSE OPSOMMING: Onderste ledemate amputasies impak negatief op `n persoon se fisiese, sielkundige en sosiale funksionering. Individue wat ’n amputasie ondergaan het benodig omvattende rehabilitasie om sosiale integrasie en ekonomiese onafhanklikheid te verseker. Konstante monitering en evaluasie is ’n essensiële deel van rehabilitasie programme. Nietemin die amputasie rehabilitasie program wat by Elangeni aangebied word, word nie gemoniteer nie en was nog nooit geëvalueer nie. Dus het hierdie studie dit ten doel om die rehabilitasie programme vir persone met onderste ledemate amputasies by Elangeni te beskryf en te evalueer. Kwantitatiewe en kwalitatiewe navorsingsmetodes is in kombinasie gebruik in die studie. Alle persone wat rehabilitasie by Elangeni ontvang het na ’n onderste ledemaat amputasie, sowel as die terapeute wat by Elangeni werk, het die studie populasie gevorm. In totaal het 32 persone aan die studie deelgeneem. Kwantitatiewe data is met behulp van `ʼn demografiese vraelys, `ʼn ICF gebaseerde vraelys, en `ʼn leer oudit vorm ingesamel. Twee onderhoud skedules, een vir die kliënte en een vir die terapeute, is gebruik as riglyn tydens insameling van kwalitatiewe data. Kwantitatiewe data is statisties ontleed deur ʼn statistikus wat gebruik gemaak het van Statistica 8. Voorafbepaalde temas is gebruik tydens tematies ontleding van kwalitatiewe data. Geen program visie, missie of doelwitte kon geïdentifiseer word nie. Swak rekord houdings praktyke was gevind. Rehabilitasie het gefokus op die fisiese en nie op sosiale integrasie nie. Die kliënte wat prostetiese rehabilitasie ontvang het, het statisties beduidend beter gevaar ten opsigte van optel van voorwerpe van die vloer af (p = 0.031), om van die vloer af op te staan (p = 0.00069), om uit die huis uit te kom (p = 0.023), om trappe met `ʼn handreling te klim (p = 0.037), om op die erf rond te beweeg (p = 0.0069), om trappe sonder `ʼn reling te klim (p = 0.037), om by sypaadjies op en af te gaan (p = 0.0082), om meer as `ʼn kilometer te loop of met die rolstoele te ry (0.0089) en om in ongure weer te loop (0.017). `ʼn Tekort aan heropleiding van mobiliteit binne die huis het `ʼn statisties beduidende impak gehad op die vermoë om goed te dra (p 0.011), op te staan van sit af (p = 0.042), in die huis rond te beweeg (p = 0.00023), voorwerpe van die vloer af op te tel (p = 0.00068), van die vloer af op te staan (p = 0.0072), uit die huis uit te kom (p = 0.0016), trappe met `ʼn handreling te klim (p = 0.019), in die erf rond te beweeg (0.0013), trappe sonder `ʼn handreling te klim (p = 0.019), by `n sypaadjie op en af te gaan (p = 0.0022), meer as 1km te loop of met die rystoel te ry (p = 0.0032) en om vervoer te gebruik (p = 0.0034). `ʼn Gebrek aan heropleiding van gemeenskapsmobiliteit het `ʼn statisties negatiewe impak gehad op alle aspekte van gemeenskapsintegrasie behalwe die doen van oorplasings en bestuur. Rehabilitasie praktyke was nie gebaseer op die sosiale model van gestremdheid en Gemeenskap Gebaseerde Rehabilitasie beginsels nie. Dit word aanbeveel dat diens verskaffers, kliënte en bestuurders oor die fokus van rehabilitasie by Elangeni moet besin. Daar moet ʼn visie en doelwitte vir die diens ontwikkel word. Voorts moet bestuurders van distrik vlak ʼn aktiewe rol speel in die monitering en evaluasie van dienste en mentorskap aan terapeute verseker.

Thesis (B.S.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING / Bibliography: leaf 88. / by Cheryl A. Gira. / B.S.

Considerando a inserção profissional como a articulação de dois componentes importantes no processo de socialização, o trabalho e a educação, a pesquisa realizada nessa dissertação objetivou identificar os elementos sócio-educativos que configuram a (re)inserção no mercado de trabalho de pessoas que sofreram amputação de membros. Inicialmente, realizou-se uma abordagem quantitativa a partir da revisão total de 169 prontuários de amputados protetizados pelo SUS, INSS e rede privada de saúde. A abordagem qualitativa da pesquisa ocorreu a partir de entrevistas semiestruturadas com profissionais do centro de reabilitação profissional do INSS/POA e aplicação da técnica do discurso do sujeito coletivo nas entrevistas com amputados gaúchos protetizados em Porto Alegre. Identificaram-se aspectos comuns nas falas dos entrevistados, relacionados à preponderância da protetização no processo de reabilitação e à relevância de retomar a atividade profissional, ainda que informalmente, para resgate da autoestima e reinclusão social, conferindo à (re)inserção profissional um papel terapêutico, além de sobrevivência. A inserção profissional é propulsionada pelas redes sociais informais, em que os contatos são peculiarmente importantes no acesso a informações sobre as vagas de trabalho, bem como as indicações para o preenchimento das mesmas. Aliás, as redes sociais aparecem como os recursos mais efetivos do que as políticas públicas afirmativas na promoção de empregabilidade. Outro aspecto significativo à (re)inserção profissional diz respeito à escolaridade, uma característica que influencia o tipo de retorno ao mercado de trabalho: quanto mais escolarizado, maior a tendência de atuação no mercado de trabalho formal, assim como a oferta de empregos por cotas reservadas a PPD´s; enquanto que para os amputados menos escolarizados, os postos de trabalho ocupados são de grande desgaste físico com base em saberes práticos, aprendidos no cotidiano de trabalho. / Whereas the occupational integration as a combination of two important components in the socialization process: the work and education, research carried out in this paper aimed to identify the social and educational elements of the (re) integration into the labor market of people who have suffered amputation of limbs. Initially, there was a quantitative approach based on the revision of 169 medical records of amputees prostheses by SUS, Social Security and private health clinics. The qualitative research took place from semi-structured interviews with professionals in the rehabilitation center professional INSS / POA and the technique of collective subject speech in interviews with amputees from Rio Grande do Sul. We identified common issues in the interviews, related to the preponderance of the prosthesis in the rehabilitation process, the importance of taking back their career, even informally, for the recovery of self-esteem and social reinsertion, giving to the (re) insertion a therapeutic role, beyond survival. The professional integration is driven by informal social networks, where contacts are uniquely important for improving access to information about job vacancies, and the information to fill them. Moreover, the social networks are resources more effective than affirmative public policies in promoting employability. Another significant aspect of (re) integration mechanisms regards to education, a characteristic that influences the type of return to the labor market: as more educated, greater tendency of activity in the formal labor market and the demand for jobs by quotas reserved for PPD´s. While for amputees less educated, the jobs are very physically demanding on the basis of practical knowledge, learned in daily work.

Current clinical practice regarding upper body prosthesis prescription and training is lacking a standarized, quantitative method to evaluate the impact of the prosthetic device. The amputee care team typically uses prior experiences to provide prescription and training customized for each individual. As a result, it is quite challenging to determine the right type and fit of a prosthesis and provide appropriate training to properly utilize it early in the process. It is also very difficult to anticipate expected and undesired compensatory motions due to reduced degrees of freedom of a prosthesis user. In an effort to address this, a tool was developed to predict and visualize the expected upper limb movements from a prescribed prosthesis and its suitability to the needs of the amputee. It is expected to help clinicians make decisions such as choosing between a body-powered or a myoelectric prosthesis, and whether to include a wrist joint. To generate the motions, a robotics-based model of the upper limbs and torso was created and a weighted least-norm (WLN) inverse kinematics algorithm was used. The WLN assigns a penalty (i.e. the weight) on each joint to create a priority between redundant joints. As a result, certain joints will contribute more to the total motion. Two main criteria were hypothesized to dictate the human motion. The first one was a joint prioritization criterion using a static weighting matrix. Since different joints can be used to move the hand in the same direction, joint priority will select between equivalent joints. The second criterion was to select a range of motion (ROM) for each joint specifically for a task. The assumption was that if the joints' ROM is limited, then all the unnatural postures that still satisfy the task will be excluded from the available solutions solutions. Three sets of static joint prioritization weights were investigated: a set of optimized weights specifically for each task, a general set of static weights optimized for all tasks, and a set of joint absolute average velocity-based weights. Additionally, task joint limits were applied both independently and in conjunction with the static weights to assess the simulated motions they can produce. Using a generalized weighted inverse control scheme to resolve for redundancy, a human-like posture for each specific individual was created. Motion capture (MoCap) data were utilized to generate the weighting matrices required to resolve the kinematic redundancy of the upper limbs. Fourteen able-bodied individuals and eight prosthesis users with a transradial amputation on the left side participated in MoCap sessions. They performed ROM and activities of daily living (ADL) tasks. The methods proposed here incorporate patient's anthropometrics, such as height, limb lengths, and degree of amputation, to create an upper body kinematic model. The model has 23 degrees-of-freedom (DoFs) to reflect a human upper body and it can be adjusted to reflect levels of amputation. The weighting factors resulted from this process showed how joints are prioritized during each task. The physical meaning of the weighting factors is to demonstrate which joints contribute more to the task. Since the motion is distributed differently between able-bodied individuals and prosthesis users, the weighting factors will shift accordingly. This shift highlights the compensatory motion that exist on prosthesis users. The results show that using a set of optimized joint prioritization weights for each specific task gave the least RMS error compared to common optimized weights. The velocity-based weights had a slightly higher RMS error than the task optimized weights but it was not statistically significant. The biggest benefit of that weight set is their simplicity to implement compared to the optimized weights. Another benefit of the velocity based weights is that they can explicitly show how mobile each joint is during a task and they can be used alongside the ROM to identify compensatory motion. The inclusion of task joint limits gave lower RMS error when the joint movements were similar across subjects and therefore the ROM of each joint for the task could be established more accurately. When the joint movements were too different among participants, the inclusion of task limits was detrimental to the simulation. Therefore, the static set of task specific optimized weights was found to be the most accurate and robust method. However, the velocity-based weights method was simpler with similar accuracy. The methods presented here were integrated in a previously developed graphical user interface (GUI) to allow the clinician to input the data of the prospective prosthesis users. The simulated motions can be presented as an animation that performs the requested task. Ultimately, the final animation can be used as a proposed kinematic strategy that a prosthesis user and a clinician can refer to, during the rehabilitation process as a guideline. This work has the potential to impact current prosthesis prescription and training by providing personalized proposed motions for a task.

The aim of this paper is to identify the influence of the Physical Therapy on patient’s self-sufficiency following the amputation of legs, during the stages of rehabilitation, and a Health Recovering Treatment. There were 30 patients (23 men and 7 women) who participated in this experiment. All the participants where the patients who came back for the Health Recovering Treatment (first time for a definitive prosthetic after the temporary prosthesis) following the amputation of one leg either in a level of thigh, or shin. The average age of male participants was 61 year, while average age of female participants – 68 year. The patient’s abilities to be self-dependant and to take care of himself were analysed while using the Bartel Index. The testees were examined in the early stage of rehabilitation (the preparation for prosthetic and the adaptability of temporary prosthesis), and in the final stage of rehabilitation (30 after starting an experiment); also in the early stage of the Health Recovering Treatment (first time definitive prosthesis was applied after temporary prosthesis), and in the final stage of the Health Recovering Treatment (24 days later). During the rehabilitation stage the patients’ self-sufficiency improved starting from almost complete dependence to an average dependence (by 20,34 points), and during the Health Recovering Treatment stage it improved from average dependence to a little dependence (by 21,40 points). The improvement in walking on a smooth... [to full text]

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1992.