Amputation patients have a great deal more than just physical recovery to contend with and the extent and scope of this condition is largely unknown in South Africa. Rehabilitation programmes for amputees, specifically at state institutions are characterised by lack of resources, lack of information provided to patients and the patients themselves seem to experience lack of support on an emotional and psychological level. This study investigates the experience of self of the amputation patient through a review of the literature available and from an ecosystemic-postmodernist viewpoint. In addition, guided imagery is examined as a technique that could add value to rehabilitation programmes for amputation patients. Health care professionals in two state hospitals in Pretoria were interviewed by means of semi-structured questionnaires to obtain additional information on current rehabilitation programmes as well as the experience of the amputation and the subsequent process for the amputee. Themes extracted from these questionnaires were used to design a suggested rehabilitation programme. This programme, based on the findings of the research, suggests certain enhancements to existing programmes and is focussed on supporting the experience of the process for the amputee through inclusion of specific guided imagery texts. / Psychology / M.A.(Clinical Psychology)

Over one million amputees are living in the United States with major lower limb loss (Ziegler-Graham et al. 2008). Lower limb amputation leads to the functional loss of the ankle plantar flexor muscles, which are important contributors to body support, forward propulsion, and leg swing initiation during walking (Neptune et al. 2001; Liu et al. 2006). Effective prosthetic component design is essential for successful rehabilitation of amputees to return to an active lifestyle by partially replacing the functional role of the ankle muscles. The series of experimental and computer simulation studies presented in this research showed that design characteristics of energy storage and return prosthetic ankles, specifically the elastic stiffness, significantly influence residual and intact leg ground reaction forces, knee joint moments, and muscle activity, thus affecting muscle output. These findings highlight the importance of proper prosthetic foot stiffness prescription for amputees to assure effective rehabilitation outcomes. The research also showed that the ankle muscles serve to stabilize the body during turning the center of mass. When amputees turn while supported by their prosthetic components, they rely more on gravity to redirect the center of mass than active muscle generation. This mechanism increases the risks of falling and identifies a need for prosthetic components and rehabilitation focused on increasing amputee stability during turning. A proper understanding of the effects of prosthetic components on amputee walking mechanics is critical to decreasing complications and risks that are prevalent among lower-limb amputees. The presented research is an important step towards reaching this goal. / text

Introduction: The increasing number of cases of lower limb loss is already recognized as a public health issue worldwide. Since amputation is potentially disabling, limiting, and leading to serious damage to functionality, it may alter the level of physical activity, nutritional status and quality of life of the individual. Objective: To evaluate the prevalence and association between the level of physical activity and excess weight and quality of life in lower limb amputees treated at the Basic Health Units of Aracaju, SE. Methods: A descriptive, cross-sectional, quantitative study with a random sample of adult individuals of both sexes submitted to amputation of unilateral lower limbs. In the sample (n = 54), overweight (BMI and neck circumference), physical activity level (IPAQ short version) and quality of life (WHOQOL-Bref) were evaluated. For the statistical analysis, the chi-square test (categorical variables), t student and Mann-Whitney (numerical variables), and a regression model were used, with a value of p <0.05. Results: 74% of the sample was classified as insufficiently active, and the male sex was identified as the most active sample. There was a significant negative association between the level of physical activity and overweight, quality of life and amputation level. The insufficiently active ones presented higher indices of excess weight, higher level of amputation and low quality of life in comparison to the active individuals. Conclusion: The level of physical activity of amputees in a lower limb was associated with overweight and aspects of quality of life. / Introdução: O crescente número de casos de perda do membro inferior já é reconhecido como uma questão de saúde pública em todo o mundo. Uma vez que a amputação é potencialmente incapacitante, limitante, e que leva a sérios danos na funcionalidade, podendo alterar o nível de atividade de física, o estado nutricional e a qualidade vida do indivíduo. Objetivo: Avaliar a prevalência e a associação entre o nível de atividade física e o excesso de peso e qualidade de vida em amputados de membros inferiores atendidos nas Unidades Básicas de Saúde de Aracaju, SE. Métodos: Estudo descritivo, transversal, quantitativo, com amostra por sorteio, de indivíduos adultos, de ambos os sexos, submetidos à amputação de membros inferiores unilaterais. Na amostra (n= 54) foi avaliado o excesso de peso (IMC e circunferência do pescoço), o nível de atividade física (IPAQ versão curta) e a qualidade de vida (WHOQOL-Bref). Para a análise estatística, foram utilizados os testes qui-quadrado (variáveis categóricas), t student e Mann-Whitney (variáveis numéricas), e um modelo de regressão, sendo o valor de p < 0.05. Resultados: 74% da amostra foi classificada como insuficientemente ativa, sendo o sexo masculino identificado como o mais ativo da amostragem. Foi observada uma associação negativa significativa entre o nível atividade física com o excesso de peso, a qualidade de vida e o nível de amputação. Os insuficientemente ativos apresentaram maiores índices de excesso de peso, maior nível de amputação e baixa qualidade de vida em comparação aos indivíduos ativos. Conclusão: O nível de atividade física de indivíduos amputados de um membro inferior associou-se com o excesso de peso e com aspectos da qualidade de vida.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-06-22T17:42:42Z No. of bitstreams: 1 jussarareginapereirabritto.pdf: 2008279 bytes, checksum: 81f1e8b058921cfb73367f7e41a7ae65 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-07T19:23:25Z (GMT) No. of bitstreams: 1 jussarareginapereirabritto.pdf: 2008279 bytes, checksum: 81f1e8b058921cfb73367f7e41a7ae65 (MD5) / Made available in DSpace on 2017-08-07T19:23:25Z (GMT). No. of bitstreams: 1 jussarareginapereirabritto.pdf: 2008279 bytes, checksum: 81f1e8b058921cfb73367f7e41a7ae65 (MD5) Previous issue date: 2014-08-25 / Os amputados traumáticos de membros inferiores apresentam maior morbidade e mortalidade por doenças cardiovasculares quando comparados à população geral. Entretanto, os fatores de risco para esse aumento de morbidade, bem como os mecanismos patofisiológicos responsáveis, ainda não estão bem esclarecidos. O objetivo do presente estudo foi testar as hipóteses que o uso da prótese em amputados transtibiais traumáticos aumenta a pressão arterial (PA) e a frequência cardíaca (FC) e diminui a variabilidade da frequência cardíaca (VFC), na postura supina (PS) e postura ortostática (PO). Foram avaliados 20 indivíduos adultos, do sexo masculino, sendo 10 com amputações transtibiais unilaterais traumáticas e 10 indivíduos sem amputações (controles). O registro da FC, para o cálculo das medidas de VFC, foi realizado por meio do monitor de frequência cardíaca Polar® modelo RS300CX e a PA foi aferida pelo método auscultatório e oscilométrico. Os grupos foram avaliados em repouso, na PS e PO, sendo os amputados submetidos ao protocolo com e sem a prótese. Para comparações intragrupo foi realizada a ANOVA 2x2 de medidas repetidas e testes t pareados; e na comparação entre grupos, utilizou-se o teste t de Student para amostras independentes. O grupo amputados, com e sem a prótese, foi observado que a FC é maior na PO comparada a PS, (82,5 ± 11,1 vs. 66,8 ± 6,7 bpm respectivamente) e que ao utilizarem a prótese a FC foi maior comparada à condição sem prótese, (76,8 ± 9,0 vs. 72,5 ± 8,0 bpm respectivamente). Analisando as variáveis autonômicas dos amputados na PO comparada a PS, eles apresentaram menores valores de iRR (763,0 ± 100,3 vs. 911,0 ± 89,9; p < 0,001), rMSSD (23,0 ± 14,0 vs. 37,7 ± 21,5; p = 0,001), pNN50 (5,9 ± 9,4 vs. 16,8 ± 18,6; p = 0,01) e HF (24,5 ± 15,0 vs. 42,8 ± 18,8; p = 0,02) e maiores valores de LF (77,1 ± 12,7 vs. 57,2 ± 18,8; p = 0,04) e LF/HF (5,9 ± 5,7 vs. 2,1 ± 1,7; p = 0,07). Quanto ao uso de prótese, foram observados menores valores de iRR (814,6 ± 92,2 vs. 859,4 ± 92,2; p = 0,001), rMSSD (26,6 ± 14,8 vs. 34,2 ± 20,1; p = 0,002) e pNN50 (8,9 ± 11,9 vs. 13,7 ± 15,4; p = 0,005) em comparação com a condição sem prótese. Comparando ao grupo controle, a FC dos amputados com o uso da prótese foi maior tanto na PS quanto na PO, ao passo que quando a prótese foi retirada, essa diferença desaparecia. Conclui-se que o uso da prótese altera as variáveis hemodinâmicas por meio do aumento da FC e da PA e das variáveis autonômicas por meio da redução da VFC. / The traumatic lower limb amputees have higher morbidity and mortality from cardiovascular disease compared to the general population. However, the risk factors for this increased morbidity, as well as the pathophysiological mechanisms responsible are not well understood. The aim of this study was to test the hypothesis that the use of the prosthesis in transtibial amputees traumatic increases blood pressure (BP) and heart rate (HR) and decreased heart rate variability (HRV) in the supine posture (PS) and standing position (PO). 20 individuals, males, 10 with unilateral transtibial amputations and traumatic amputations 10 individuals without (controls) were evaluated. The registration of the FC, for the calculation of measures of HRV was performed by means of the heart rate Polar ® RS300CX model and BP monitor was checked by auscultation and oscillometry. The groups were evaluated at rest, the PS and PO, being amputees undergoing the protocol with and without the prosthesis. For intragroup comparisons 2x2 ANOVA repeated measures and paired t tests were performed; and comparison groups was used for independent samples Student's t test. The amputee group, with or without the prosthesis, it was found that FC is larger compared to PO the PS (82.5 ± 11.1 vs. 66.8 ± 6.7 beats per minute respectively) and that when using the prosthesis HR was higher compared to unaided, (76.8 ± 9.0 vs. 72.5 ± 8.0 bpm respectively). Analyzing the autonomic variables of amputees in PO compared to PS, they had lower values of RR intervals (763.0 ± 100.3 vs. 911.0 ± 89.9, p <0.001), rMSSD (23.0 ± 14.0 vs. 37.7 ± 21.5, p = 0.001), pNN50 (5.9 ± 9.4 vs. 16.8 ± 18.6, p = 0.01) and HF (24.5 ± 15.0 vs. 42.8 ± 18.8, p = 0.02) and higher values of LF (77.1 ± 12.7 vs. 57.2 ± 18.8, p = 0.04) and LF / HF (5.9 ± 5.7 vs. 2.1 ± 1.7, p = 0.07). Regarding the use of prosthesis, lower values of RR intervals (814.6 ± 92.2 vs. 859.4 ± 92.2, p = 0.001) were observed, rMSSD (26.6 ± 14.8 vs. 34.2 ± 20.1, p = 0.002) and pNN50 (11.9 ± 8.9 vs. 13.7 ± 15.4, p = 0.005) compared to the unaided. Compared to the control group, HR amputees using prostheses was higher both in PS as in PO, whereas when the prosthesis was removed, this difference disappeared. We conclude that the use of the prosthesis alters hemodynamic variables by increasing HR and BP and autonomic variables by reduced HRV.

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Bakgrund: Majoriteten av de personer som genomgått ett amputationsingrepp drabbas av fantomsmärta. Trots att fantomsmärta är ett vanligt fenomen inom denna patientgrupp så är det ofta missförstått och det föreligger problem förknippade med hanteringen av fantomsmärtor. Tidigare forskning har visat inkonsekventa resultat som varierar från en forskare till en annan och komplexiteten med fantomsmärta har lett till behandlingsresultat med varierande effekt. I första hand har farmakologisk behandling använts, men många patienters smärta förblir refraktär mot farmakologiska medel och kräver därför andra alternativ. En alternativ behandling som först föreslogs i början på 1990-talet i vårdandet av fantomsmärta är spegelterapi. Spegelterapi kan användas som en omvårdnadsåtgärd för att smärtlindra fantomsmärtor och ska minska den amputerade kroppsdelens smärta.Syfte: Syftet med föreliggande litteraturstudie är att belysa effekten av spegelterapi som en omvårdnadsåtgärd för smärtlindring av fantomsmärtor.Metod: Metoden som använts är systematisk databassökning i databaserna PubMed och Cinahl. Litteraturstudien baseras på 10 vetenskapliga studier med kvantitativ studiedesign.Resultat: Litteraturstudiens syfte blev besvarat och kunde fastställa att spegelterapi har en smärtlindrande effekt för fantomsmärtor. Ett bifynd var att interventionen även bidrar till enförbättrad livskvalitet. Således delades resultatet in i två huvudteman: Spegelterapins smärtlindrande effekt utifrån olika smärtskattningsskalor samt påverkan på livskvaliteten. De frågor som ställts är om spegelterapi är en omvårdnadsåtgärd som kan användas i praktiken.Konklusion: Spegelterapi har en smärtlindrande effekt och minskar fantomsmärtor. Ett bifynd var att interventionen även bidrar till en förbättrad livskvalitet samt ökar välmåendet hos amputerade personer som lider av fantomsmärtor. Spegelterapi hade kunnat användas i praktiken efter att ha blivit optimerad och där en standardmetod för spegelterapi tagits fram. Däremot krävs det vidare forskning om spegelterapi. / Background: The majority of amputees suffer from phantom pain. Although phantom pain isa common phenomenon, it is often misunderstood and there are often problems with themanagement of phantom pain. Previous research has shown inconsistent results that varyfrom one researcher to another. The complexity with phantom limb pain has led to treatmentresults with varying effects. Primarily pharmaceuticals have been the main treatment. But many patients' discomfort still remains and the need for alternative treatment options isimperative. One alternative treatment is mirror therapy which was first suggested in thebeginning of the 1990’s century. Mirror therapy is supposed to reduce the phantom limb pain.Aim: The aim of this literature review is to highlight the effect of mirror therapy as a nursing treatment for reducing phantom limb pain.Method: The method that is used is a systematic database search in PubMed and Cinahl. The literature study is based on 10 scientific articles with a quantitative study design.Result: The literature study proved that mirror therapy is effective for reducing phantom limb pain. A secondary finding was the improvement of quality of life. Therefore the result was divided into two main themes: Change in phantom pain based on different pain assessment scales and the impact on the quality of life. Questions that were asked are whether mirror therapy is an intervention that can be used in the treatment of the phenomenon.Conclusion: Mirror therapy does reduce phantom pain in amputees. A secondary finding was that the intervention also contributes to a better quality of life and increases the well-being for the amputee. Mirror therapy could be practically applied after a standard method has been produced. However, further research is needed on mirror therapy.

Bakgrund Amputation innebär att individen förlorar en liten eller stor del av kroppen som inte kan ersättas. Orsaken till amputation kan vara kärlsjukdomar, diabetes samt trauma. Amputation kan medföra fysiska och psykiska förändringar i patientens liv. Omvårdnad av dessa patienter kan vara komplex, sjuksköterskan har i sin profession en betydande roll i mötet med patienten. Syfte Syftet var att beskriva patienters upplevelser och erfarenheter efter amputation av nedre extremitet. Metod En icke systematisk litteraturöversikt genomfördes utifrån Fribergs metodbeskrivning. Sjutton originalartiklar inhämtades via databaserna PubMed och Cinahl Complete. Valda artiklar, kvalitetsgranskades och analyserades genom en integrerad analysmetod. Resultat Efter sammanställning av de nitton studierna identifierades två övergripande rubriker: Fysiologiska upplevelser och erfarenheter, psykologiska upplevelse och erfarenheter. varje kategori hade två underkategorier. Eftersom vi undersöker patientens upplevelser och erfarenheter efter amputation har vi valt att inkludera flera faktorer som påverkar patientens livskvalitet såsom sexualitet, smärta, depression och kroppsbild. Dessutom har vi även valt att inkludera benprotesens samt ADLs funktion som en faktor eftersom funktionaliteten är en viktig del av livskvaliteten. Slutsats Amputation leder till stor förändring i patientens liv, kan orsaka lidande i både den fysiska och psykiska hälsan, och ger svårigheter i patientens framtida liv. Det är viktigt som sjuksköterska att förstå och ha kunskap om den påfrestning som uppkommer efter amputation för att ge den specificerade vård som behövs i samarbete med andra yrkesgrupper för att möjliggöra att patienten ska kunna återgå till ett så normalt liv som möjligt. / Background Amputation means that the individual loses a small or large part of the body which cannot be replaced. The cause of amputation can be vascular disease, diabetes and trauma. Amputation causes physical and mental changes in the patient's life. Patient care can be complex, therefore the nurse has a significant role when interacting with patients who have undergone amputation. Purpose The purpose was to describe patients experiences after amputation of the lower extremity. Method Non-systematic literature review was performed based on Friberg's method description. Seventeen original articles were obtained via the databases PubMed and Cinahl Complete. Selected articles were quality reviewed and analyzed through an integrated analysis. Results After compiling the seventeen studies, two main categories were identified: Physiological experiences and experiences, psychological experience and experiences. Each category had two subcategories. Because we examine and study the patient's experiences after amputation, we have chosen to include several factors that affect the patient's quality of life such as sexuality, pain, depression and body image. In addition, we have also chosen to include the function of bone prosthesis and ADL as a factor because functionality is an important part of the quality of life. Conclusions Amputation leads to great change in the patient's life, which can cause suffering in physical and mental health and difficulties in the patient's future life. It is important as a nurse to understand and have knowledge of the stress that arises after amputation to provide the specified care needed in collaboration with other professions to enable the patient to return to a normal life as possible.

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Introduction: Les implants dans le système nerveux périphérique (SNP) peuvent potentiellement restaurer les capacités sensorielles et motrices chez les patients avec des amputations des membres supérieures. Cependant, la réaction à un corps étrangers affecte significativement la fonction à long-terme et la biocompatibilité de ces systèmes avec le temps. Le dendrimère (DND) et la Poly-D-Lysine (PDL) sont deux polymères synthétiques qui peuvent potentiellement améliorer la performance de ces implants. Pour cette étude, notre objectif est de déterminer si ces polymères peuvent promouvoir la formation d’éléments présynaptiques sur des surfaces synthétiques in vivo dans un modèle animal. Méthodes: Pour l’étude in vivo, nous avons utilisé un modèle d’écrasement du nerf sciatique chez le rat. Des billes enduites de DND et PDL et contrôle ont été injectées dans le nerf sciatique aux sites d’écrasement et 5 mm distaux au site d’écrasement. Après 4, 6 et 8 semaines, les nerfs ont été retirés et marqués avec des anticorps spécifiques au neurofilament et à la synaptophysine. Nous avons ensuite compté le nombre d’éléments présynaptiques retrouvant sur la surface de chaque bille pour toutes les conditions. Pour l’étude de l’électrode, deux électrodes ont été implantées dans le nerf sciatique du rat. Nous avons ensuite effectué des enregistrements nerveux à chaque semaine, et le potentiel d’action dans le nerf a été mesuré en variant uniquement la largeur de l’impulsion. Résultats: L’étude in vivo a démontré que les billes enduites de DND pouvaient promouvoir une accumulation significative de synaptophysine sur leurs surfaces comparé aux billes contrôles de 4 à 8 semaines. À 4 semaines, les billes dans la condition DND avaient également une accumulation de synaptophysine significativement supérieure à celles dans la condition PDL pour le site distal à l’écrasement. L’étude de l’électrode a démontré que les deux électrodes pouvaient stimuler et acquérir des signaux nerveux du nerf sciatique jusqu’à 1 et 2 semaines respectivement avant de ne plus fonctionner. Conclusion: Les résultats de notre étude suggèrent que DND possède une propriété à promouvoir la synaptogenèse qui est supérieure à PDL in vivo et que notre modèle d’électrode peut être utilisé pour évaluer la stabilité du signal des implants SNP. / Background: Implants in the peripheral nervous system (PNS) can potentially restore sensory feedback, improve motor control and alleviate phantom-limb pain in upper-limb amputees. However, nervous system implants have poor long-term function and biocompatibility when implanted into the body due to foreign body reaction. Dendrimer (DND) and Poly-D-Lysine (PDL) are two synthetic polymers with properties that could improve the performance of these interfaces. In my masters’ research, my objective is to determine whether these synthetic polymers could promote the formation of presynaptic elements on artificial surfaces in vivo making intraneural implants more biocompatible and long-lasting. Methods: In the coated microsphere in vivo experiment, a nerve crush injury model in the rat was used for the study. PDL-coated, DND-coated and uncoated beads were injected into the rat sciatic nerve at the crush site and 5 mm distal to the crush site. The nerves were then harvested after 4, 6 and 8 weeks and stained for neurofilament and synaptophysin. Synaptophysin puncta were then counted on the bead surface for each group. Additionally, in a proof-of-concept experiment, two uncoated electrodes were implanted into the rat sciatic nerve. Nerve recordings were then performed every week, and the threshold nerve potential in the sciatic nerve was measured by only varying the pulse duration of the stimulation. Results: The coated microsphere in vivo experiment demonstrated that DND-coated microspheres had a significantly higher number of synaptophysin puncta around their surface from 4 to 8 weeks compared to uncoated beads. At 4 weeks, the DND condition also showed a significantly higher number of synaptophysin puncta around its microbeads vs. the PDL condition for the distal site. In the uncoated electrode in vivo experiment, the results showed that the two implants could stimulate and record threshold nerve potentials in the rat sciatic nerve for one week and two weeks respectively before being non-functional. Conclusion: Our study showed for the first time that DND has a stable synapse-promoting property that is superior to PDL in vivo and that our electrode design can be used to assess the long-term signal stability of peripheral nerve implants.