Thesis (M.S.)--Wisconsin. / Includes bibliographical references (leaves 209-221).

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Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (p. 329-334).

Upper limb deficiencies in children may be the result of trauma, disease, or congenital problems. Although biomechanical losses are the primary problem associated with a limb deficiency, the loss of such an obvious body part has cosmetic and psychosocial implications as well. Fitting a child with a prosthesis typically is the treatment chosen by families. Presently, there are three types of prostheses available for pediatric amputees, including passive, cable-operated, and myoelectric arms, but the myoelectric appears to be the most popular choice of children and their families. However, there is growing concern among clinicians that, despite its advanced technological capabilities, the myoelectric prosthesis is chosen for aesthetic rather than functional reasons. It is difficult, then, to justify the expense of fitting a myoelectric prosthesis when a more inexpensive prosthesis, or none at all, would be a more appropriate prescription. The question of when to prescribe a myoelectric prosthesis for a pediatric patient remains one of the most controversial questions in the field of prosthetics today due to this cost/benefit issue. In this study, the researcher examined psychological factors that may influence whether or not a child will wear a prosthesis and how that prosthesis will be used. Thirty prosthetics patients of Texas Scottish Rite Hospital for Children and their parents answered questionnaires indicating self-perception, social acceptance, and family functioning. A prosthetic usage diary also was completed. Results indicated a significant relationship between optimal residual limb length and increased wearing time. Other trends in the data are discussed. Consideration of these variables by medical staff can be useful in developing appropriate expectations of adherence to treatment by the patient and the family. Recommendations are made for the prescription of pediatric prostheses that are both cost-effective and beneficial.

Adjustment difficulties can be a common problem for people with acquired physical disability. Depression can often be a sign that a person is having difficulties adjusting to and accepting change. One group of people with acquired disability are those who have had a limb amputated due to trauma, cancer, vascular disease or a congenital condition. People who have had an amputation are more likely develop depression than the general population. This study is an investigation into some of the factors (coping strategies, mood, and personality variables) associated with adjustment to amputation. Forty individuals with amputations were asked to complete a set of questionnaires and participate in a short taped interview. Coping strategies were measured using the COPE and personality variables were measured using the Structural Profile Inventory (SPI). Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HAD). Life satisfaction was measured using the Life Satisfaction Index (A) (LSI). The HAD and LSI were used as indicators of possible adjustment difficulties. Short interviews were also conducted to find out about people's perception of the care that they had received and if these were related to coping strategies. Statistical analysis showed that two coping strategies, positive reinterpretation and growth, and humour, were both associated with higher levels of life satisfaction. Mental disengagement was associated with lower levels of life satisfaction. Personality variables were associated with coping strategies. Two personality variables (Behaviour and Affect) were related to life satisfaction and anxiety. Qualitative analysis of interviews showed that people valued the support of other amputees and wanted services to provide more access to information about the range of artificial limbs available to them. The findings supported the hypothesis that personality is related to the use of particular coping strategies. This could help inform clinical practice, psychological intervention, and physical rehabilitation programmes.

As is well known, users can make significant contributions to innovations, including innovating themselves. However, much work on user innovation has focussed on developed countries. The question remains whether and how users innovate in a developing country setting. Bodies of literature that explicitly consider innovations in such settings emphasise the influence of limitations. This thesis therefore investigates how limitations shape the creation and sharing of innovations by users. This issue is analysed for medical technologies, because these can have different user groups, including patients, who have been little focussed on, even in developed countries. In this setting, a focus on innovation as defined relatively inclusively is most suitable, and therefore the term 'changes' is often used rather than 'innovations' to express this inclusiveness. By comparing the changes made to the same kind of technology by different groups of users in different settings with different limitations, the influence of these limitations can be analysed. Therefore, data were collected on changes made by patients as well as orthopaedic technicians to lower limb prostheses in two orthopaedic centres in Malawi. First, observations were conducted of the production process for prostheses, followed by semi-structured interviews with orthopaedic technicians and patients, and with additional experts to understand the broader context. It was found that patients and orthopaedic technicians did make many changes. Three kinds of limitations were identified, that influence these changes by users. Like users in developed countries, patients and orthopaedic technicians make these changes to fulfil their needs because available products and services are not satisfactory. Limitations both restrict what products and services are available to users, and also influence the characteristics of the creation and sharing of changes by users. Many users reported on efforts to share their changes with others despite the limitations, often due to a sense of professional collegiality and solidarity. In summary, limitations help to explain how changes by users occur in developing countries, but also how any accumulation of such changes users make is restricted. Improving this situation could help less developed countries in making better use of any user innovations that do occur, and thus contribute to their development more generally.