BACKGROUND: Based on mainly vascular diseases and traumatic injuries, around 40,000 upper limb amputations are performed annually worldwide. The affected persons are strongly impaired in their physical abilities by such an intervention. Through myoelectric prostheses, affected persons are able to recover some of their abilities. METHODS: In order to control such prostheses, a system is to be developed by which electromyographic (EMG) measurements on the upper extremities can be carried out. The data obtained in this way should then be processed to recognize different gestures. These EMG measurements are to be performed by means of a suitable microcontroller and afterwards processed and classified by adequate software. Finally, a model or prototype of a hand is to be created, which is controlled by means of the acquired data. RESULTS: The signals from the upper extremities were picked up by four MyoWare sensors and transmitted to a computer via an Arduino Uno microcontroller. The Signals were processed in quantized time windows using Matlab. By means of a neural network, the gestures were recognized and displayed both graphically and by a prosthesis. The achieved recognition rate was up to 87% across all gestures. CONCLUSION: With an increasing number of gestures to be detected, the functionality of a neural network exceeds that of any fuzzy logic concerning classification accuracy. The recognition rates fluctuated between the individual gestures. This indicates that further fine tuning is needed to better train the classification software. However, it demonstrated that relatively cheap hardware can be used to create a control system for upper extremity prostheses.

Traditionally, the mechanical testing of ankle-foot orthoses (AFOs) has been performed with simple limb surrogates, typically with a single axis ankle joint and rigid foot and shank components. Since many current AFO designs allow 3D motion, a surrogate lower limb (SLL) that provides anatomically similar motion in all planes is needed to enable realistic load testing and cyclic testing in a controlled manner. The aim of this thesis was to design, fabricate and test a novel SLL that provides anatomically realistic 3D foot motion, based on a consensus of the passive lower limb range of motion (RoM) found in the literature. The SLL design was inspired by the Rizzoli model, sectioning the lower limb into five segments (shank, hindfoot, midfoot, forefoot, toes). Ball and socket joints were used for the shank-hindfoot, hindfoot-midfoot, and midfoot-forefoot. Forefoot-toes used a hinge-type joint. 3D printed flexible thermoplastic polyurethane (TPU) snap-fit connectors connected the 3D printed nylon foot blocks. A threaded ball stud connected the shank shaft and hindfoot. This shank shaft was surrounded by a 3D printed polylactic acid (PLA) shank cover. The foot was cast in silicone rubber to emulate soft tissue, with a PLA custom mould based on a Össur prosthetic foot cover model. The SLL was successfully designed for easy fabrication using readily available techniques, materials, and components. Only the metal shaft required additional machining. 3D printed components used an affordable 3D printer (Artillery Sidewinder X1), and readily available nylon, PLA, and TPU. Using motion capture testing, SLL foot rotation angles were found to be within standard deviation of mean foot passive rotation angle ranges found in the literature, showing that most joints were within 5° of target maximum rotation angles. With load testing, the SLL was shown to survive static loads representing 1.5 times body weight for a 100 kg individuals and cyclic loads representing normal gait loading for 500,000 cycles.

This paper presents a novel approach to the design of a motorized rehabilitation device – active elbow orthosis (AEO) – inspired by the principles of robotic exoskeletons. The device is currently designed for the elbow joint, but can be easily modified for other joints as well. AEO determines the motion activity of the patient using a strain gauge and utilizes this measurement to control the actuator that drives the forearm part of the orthosis. Patient activity level is related to a free arm measurement obtained via a calibration procedure prior to the exercise. A high-level control module offers several types of exercises mimicking the physiotherapist. The device was successfully verified by tests on a number of patients, resulting in extended range of elbow-joint motion.

Les personnes amputées de membre inférieur (PAMI) sont très diversifiées. Ils’agit d’une population hétérogène, tant par ses origines que par ses niveaux d’amputation, ses capacités et ses projets de vie. A ces profils variés s’ajoutent une multitude de composants prothétiques ainsi que les différentes combinaisons possibles entre ces composants. Il est également important de prendre en compte les différents environnements auxquels la PAMI est confrontée quotidiennement. La Classification Internationale du Fonctionnement (CIF 2001) a été créée par l’Organisation Mondiale de la Santé et repose sur un modèle multidimensionnel. Elle est constituée de deux grandes parties : le fonctionnement d’une part et les facteurs contextuels d’autre part. Ce modèle est capable de décrire de manière globale les modifications de fonctionnement (handicap) à partir d’un problème de santé quelconque. Ainsi, une grande quantité d’informations peut être obtenues à partir du modèle de la CIF. Néanmoins, il demeure nécessaire de développer de nouveaux outils pour mieux exploiter ce modèle afin de le rendre plus intelligible et utilisable en pratique clinique courante. Pour cela, nous nous proposons d’utiliser l’Extraction de Connaissances à partir des Données (ECD). L’ECD est un processus non trivial d'identification des structures inconnues, valide et potentiellement exploitable dans les bases de données, qui permet de transformer un maximum d’informations en connaissances facilement exploitables. A partir du modèle de la CIF et conjointement avec des méthodes d’ECD, l’objectif de cette thèse est de caractériser un groupe de PAMI expertes en termes de capacités locomotrices. Ce groupe et sa liste d’indicateurs pertinents reposant sur le modèle de la CIF ont été déterminés. Ils servent de référence pour la comparaison d’autres PAMI et peuvent guider la prise en charge de cette population particulière. / The subjects with a lower-limb amputation (LLA) compose a heterogeneouspopulation, by their amputation origins, by their amputation levels, by their abilities and by their life projects. To these various LLA’s profiles we could add a multitude of prosthetic components and the combination of these components. It is also important to take into account the different environments, which the LAA are confronted daily. The International Classification of Functioning, Disability and Health (ICF 2001) was created by the Word Heath Organization and is based on a multidimensional model. The ICF is constituted by two domains: the functioning on one hand and the contextual factors on the other hand. This comprehensive-global model is able to describe the functioning (disability) from any health problem. However it remains necessary to develop new tools to better use the ICF model making it more intelligible and useful in clinical practice. For this, we proposed to use the Knowledge Discovery in Database (KDD). KDD is a non-trivial process of identification of unknown, valid and potentially-exploitable structures in database. KDD permits to transform a maximum of information in easy-exploitable knowledge. From the ICF model conjoint with KDD methods, the aim of this thesis was to characterize an expert group of LLA in terms of locomotion capacity. This group and its list of relevant indicators, based on the ICF model, were determined. They can be used as a reference to compare with others LLA improving making decision of this particular population.

Purpose: Young adolescent females are at the highest risk of sustaining an ACL injury, which may alter their movement and muscle activation patterns yet there is a lack sex- and age- specific guidelines for ACL injury management. The purpose of this study was to (1) evaluate the effects of limb dominance in a healthy uninjured population to serve as a baseline for the ACL-deficient cohort and (2) provide evidence of the neuromuscular patterns and biomechanical loading of uninjured and ACL-deficient knee joints in a female paediatric population. Methods: Eighteen active female adolescents with ACL rupture (ACLd) and 21 uninjured female adolescent controls matched for limb dominance (CON) participated in this study. Participants completed bilateral squats and drop vertical jumps (DVJ) while lower limb electromyography, kinetics and kinematics data were collected. Muscle synergies were extracted using a concatenated non-negative matrix factorization (CNMF) framework and compared between limbs, (CON dominant vs CON non-dominant and CON vs ACLd) across tasks and between limbs within tasks using intraclass correlation coefficients and statistical paramedic mapping. Results: ACLd participants took significantly longer to perform the squat relative to their uninjured peers. No significant differences were found for hip, knee and ankle peak joint flexion angles and moments between populations for the squat. Squat and DVJ muscle synergies were equivalent for dominant and non-dominant uninjured control limbs. ACL injured (ACL deficient and contralateral limbs) exhibited greater variability in DVJ synergy vectors than for the squat task. When comparing across tasks, scaling coefficients were consistently higher for the DVJ for all populations. Conclusion: Differences in lower limb kinematics, muscle activity and muscle activation patterns between dominant and non-dominant limbs indicate that limb symmetry, a clinical tool commonly used to assess rehabilitation and return to play may not provide relevant results. DVJ scaling factors were larger than those of the squat for all groups, likely due to the increased demand of that task. ACLd and CON participants completed squats and DVJ with similar lower limb joint angle patterns and muscle activity. ACL injured groups had fewer consistent vectors across tasks demonstrating greater variability in muscle activation patterns. This increased variability may be due to the ACL injury however, as injured participants were not studied pre- injury it cannot be confirmed.

The 2.06 to 2.054 Ga Bushveld Igneous Complex intruded into the sedimentary rocks of the Transvaal Supergroup and generated an extensive contact metamorphic aureole mainly developed in the upper Pretoria group. The studied samples represent the Silverton Daspoort and Timeball Hill formations and are divisible into garnet bearing hornfels (DY918, DY954 and DY956) and garnet-free staurolite-bearing metapelites (DY916, DY982 and DY987). The garnet-bearing hornfelses marks the garnet zone within the aureole and the garnet formation is controlled by different reactions forming from 490 to 630 0C. On the other hand, the garnet free staurolite-bearing Fe-Al rich metapelites define the staurolite zone restricted to the Timeball Hill formation. The recorded P-T conditions in G0 and G1 garnets of the DY954 hornfels imply that the two garnets formed under different conditions indicating two stages of metamorphism. However, the Lu-Hf isotope systematics of these garnets records a 2061 Ma age for all garnet porphyroblasts in both the DY918 and DY954 hornfelses, which support co-genetic garnet growth regardless of their stratigraphic positions. Therefore, the 2061 Ma garnet age denote the emplacement age of the Lower Zone and Critical Zone magmas which was synchronous with the extrusion of the Rooiberg Group volcanics. The fact that all analysed garnets do not record the 2059 – 2054 intrusion of the Main Zone and Upper Zone magmas probably means that the crystallisation temperatures of the later magma pulse was not significant enough to shift the Lu-Hf isotopic signatures. Euhedral staurolites are widespread within the Fe-Al rich metapelites with grain sizes of up 4mm; texturally the majority of them have been altered or overgrown by biotite and chloritoid. The alteration or of these staurolite porphyroblasts is due to isobaric cooling during uplift, and the St-Bt assemblage represent the peak equilibrium conditions and marks the upper stability limit of the Chl-Ctd assemblage. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Geology / unrestricted

Background: Parkinson's disease (PD) is a debilitating progressive neurological disorder. The main clinical features of PD are: rigidity, bradykinesia, akinesia, and resting tremor. People living with PD often present with impaired gross- and fine upper-limb motor control and ocular tracking. The impaired motor control associated with PD results in difficulty performing basic- and instrumental activities of daily living (BADLs and IADLs). Virtual reality (VR) therapy is an emerging treatment strategy used to address movement impairment in people with neurological diseases, but has not been extensively researched in the rehabilitation of people with PD. This study aimed to determine the effectiveness of VR therapy as a treatment modality for the rehabilitation of upper-limb function during BADLs and IADLs and ocular tracking for people with PD, when compared to conventional physiotherapy. Methods: A single blind randomised control trial was done. Participants were randomly allocated to either the conventional therapy (control) or VR therapy (experimental) groups using the concealed opaque envelope method. Twenty-two participants who gave informed consent were included, if they met the following criteria: Confirmed PD diagnoses; scored above 24/30 for the Mini Mental State Examination; and did not suffer from uncontrolled co-morbid diseases. The control- and experimental groups underwent twelve intervention session of 45 minutes. The control group participated in conventional physiotherapy sessions and the experimental group used the X-box Kinect© VR apparatus during treatment. Participants were assessed at baseline and post-intervention (directly following the 12 session) with the: 9 Hole Peg Test (9HPT), Test d'Evaluation des Membres Superieurs De Personnes Agees (TEMPA) and the King Devick Test. Results: The TEMPA was used to determine unilateral- and bilateral upper-limb function during IADLs and BADLs. Three of the four items of the TEMPA that assessed bilateral upper-limb function indicated statistically significant improvement when the difference between the control and experimental groups were compared post-intervention (Task1 p=0.611; Task 2 p=0.0043; Task 3 p=0.0078; Task 4 p=0.0002). Similarly, three of the four items of the TEMPA that assessed unilateral upper-limb function indicated statistically significant improvement for the experimental group, when compared to the control- group post-intervention (Task 5 p=0.0151; Task 6 p=0.4118; Task 7 p=0.0064; Task 8 p=0.0009). The 9HPT assessed in-hand manipulation and fine upper-limb function. Results from the 9HPT for the left- and right hands of both groups showed clinically significant improvements from baseline to post-intervention, but there was no statistically significant difference between the two groups. The King Devick test was used to assess ocular tracking. The comparison of change between the two groups from baseline to post-intervention on the King Devick did not indicate clinically- or statistically significant change. Discussion and Conclusion: The findings from the bilateral IADL and BADL tasks as measured with the TEMPA are similar to findings in the literature. The results show that VR therapy improve motor control of the upper-limb significantly when both hands work together and when the upper-limbs are moving unilaterally. VR therapy might be more effective than conventional physiotherapy because it allowed for repetitive practice of functional activities, which aided the development of limb control and functional muscle strength. The VR therapy also allowed task-oriented training to occur repetitively. Task-oriented training is known to aid neural plasticity and facilitate functional rehabilitation. The insignificant differences between the groups on the 9HPT is an indication that the task performed for this outcome measure is not specific enough to detect hand function and grip strength. The King Devick test did not indicate change for the control- or experimental groups, which indicates that specific ocular tracking exercises should be included in therapy to address this impairment. / Dissertation (MPhysiotherapy)--University of Pretoria, 2016. / Physiotherapy / MPhysiotherapy / Unrestricted

Bakgrund: Fantomsmärta upplevs av cirka 50-85% av alla som genomgår amputation. Antalet amputationsingrepp ökar i världen likväl som i Sverige, detta på grund av en generellt åldrande befolkning samt ökad sjukdomsprevalens. Trots ett så pass vanligt förekommande fenomen är patienters erfarenheter sparsamt beskrivet och då även i svensk vårdkontext. Syfte: Syftet med detta arbete är att beskriva patienters erfarenheter av att leva med fantomsmärta efter amputation.  Metod: Åtta kvalitativa studier identifierades till denna studie. Relevanta data söktes fram i CINAHL och PubMed. Innehållsanalys utfördes med inspiration av Fribergs modell, innehållande fem steg. Resultat: Patienters erfarenheter av fantomsmärta presenteras i fyra kategorier och nio subkategorier: Olika dimensioner av smärta, Självbild i förändring, Nya utmaningar i vardagslivet och Behöver stöd från omgivningen. Konklusion: Att leva med fantomsmärta är komplext. Amputation medför en förändringsprocess med både påfrestningar och begränsningar men också anpassning till en förändrad livssituation. Livskvalitet trots dessa utmaningar är möjligt och som sjuksköterska är det således essentiellt att identifiera varje enskild patients hinder för och möjligheter till anpassning. Detta för att gemensamt uppnå hälsa i största möjliga mån. / Background: Phantom limb pain occurs in circa 50-85% of all the cases of amputation. Amputations are increasing worldwide as well as in Sweden because of an ageing population and an increase of disease-prevalence. Although phantom limb pain is common, there is a lack of knowledge and information when it comes to patients’ experiences. Aim: The aim of this study is to describe patients’ experiences of living with phantom limb pain after amputation. Methods: Eight qualitative studies were identified for this review. Relevant data was collected from CINAHL and PubMed. Qualitative content analyses were conducted, inspired by Friberg’s five step model for analysis.  Results: Patients’ experiences of phantom limb pain were presented in four categories and nine subcategories: Different dimensions of pain, Self-image in change, New challenges in everyday-life and The need of support from the surroundings.  Conclusion: Living with phantom limb pain is complex. Amputation induces a process of change, presenting limitations, stresses and a need to adapt. However, good quality of life is possible and as a nurse it is essential to identify patients’ possibilities and obstacles to strive for the best possible health care.

Objectives: Our thesis is focused on correlation of lateral (side) preferencies of lower limbs and quality of sensorimotor control. Our aim is to figure out whether there is difference in laterality of sensorimotor control of lower limbs and if so, whether there is correlation with side preferency. Methods: Study is made on 18 volunteers. We tested somatosenzoric system, specifically two-point discrimination, graphesthesia, pallesthesia, statesthesia, kinesthesia. We used a questionnare to determine side preferency of lower limbs. We used paired sample t- tests, with level of importance p=0,05. Results: According to t-tests, there are no differencies in sensorimotor control in lower limbs. According to those results, it is not possible to determine the difference in sensorimotor control due to lower limb preferency. Summary: There is no difference in sides in sensorimotor control of lower limbs.

Changes in the external surfaces on the lower limb bones can be caused by various taphonomic factors. It is important for our work how these changes will affects. The aim of the work was to process and subsequently evaluate the changes in the external surfaces on the lower limb bones. For analyses we chose set of adults from 2nd church burial ground Pohansko near Břeclav, we chose specifically braid of the lower limbs (cingulum membri inferioris) and free lower limb (pars libera membri inferioris). We wrote down taphonomic changes into prepared protocols, changes were typologically about damages and color changes. We used programs InkScape and AdobePhotoshop to transform paper protocols into digital form. Heat maps are outputs from this programms through them we are able to see incidence rate of individual changes. We most often detected the occurrence of an orange color on the bones of the lower limbs, so we focused on its cause. We found an increased content of silicon and aluminum in its chemical composition, so we assume that it could be an aluminosilicate weathering product. Key words: Pohansko, taphonomy, taphonomic factors, bone surface, lower limb