L'analyse du mouvement humain s'appuie généralement sur des techniques de suivi de marqueurs cutanés pour reconstruire la cinématique articulaire. Cependant, ces techniques d'acquisition présentent d'importantes limites dont les " artefacts de tissus mous " (i.e., le mouvement relatif entre les marqueurs cutanés et le squelette sous-jacent). La méthode d'optimisation multi-segmentaire viseà compenser ces artefacts en imposant aux trajectoires de marqueurs les degrés de liberté d'un modèle cinématique prédéfini. Les liaisons mécaniques modélisant classiquement les articulations empêchent toutefois une estimation satisfaisante de la cinématique articulaire. Cette thèse aborde des perspectives d'amélioration de la méthode d'optimisation multi-segmentaire pour l'estimation de la cinématique articulaire du membre inférieur,à travers différentes approches : (1) la reconstruction de la cinématique par suivi de la vitesse angulaire, de l'accélération et de l'orientation de centrales inertiellesà la place du suivi de marqueurs, (2) l'introduction d'un modèle articulaire élastique basé sur la matrice de raideur du genou, permettant une estimation physiologique de la cinématique articulaire et (3) l'introduction d'un modèle des artefacts de tissus mous " cinématique-dépendant ", visantà évaluer et compenser les artefacts de tissus mous simultanément avec l'estimation la cinématique articulaire. Ce travail a démontré la polyvalence de la méthode d'optimisation multi-segmentaire. Les résultats obtenus laissent espérer une amélioration significative de cette méthode qui devient de plus en plus utilisée en biomécanique, en particulier pour la modélisation musculo-squelettique / Human movement analysis generally relies on skin markers monitoring techniques to reconstruct the joint kinematics. However, these acquisition techniques have important limitations including the "soft tissue artefacts" (i.e., the relative movement between the skin markers and the underlying bones). The multi-body optimization method aims to compensate for these artefacts by imposing the degrees of freedom from a predefined kinematic model to markers trajectories. The mechanical linkages typically used for modeling the joints however prevent a satisfactory estimate of the joint kinematics. This thesis addresses the prospects of improvement of the multi-body optimization method for the estimation of joint kinematics of the lower limb through different approaches: (1) the reconstruction of the kinematics by monitoring the angular velocity, the acceleration and the orientation of magneto-inertial measurement units instead of tracking markers, (2) the introduction of an elastic joint model based on the knee stiffness matrix, enabling a physiological estimation of joint kinematics and (3) the introduction of a "kinematic-dependent" soft tissue artefact model to assess and compensate for soft tissue artefact concurrently with estimating the joint kinematics. This work demonstrated the versatility of the multi-body optimization method. The results give hope for significant improvement in this method which is becoming increasingly used in biomechanics, especially for musculoskeletal modeling

Made available in DSpace on 2014-07-29T15:04:30Z (GMT). No. of bitstreams: 1 dissertacao marleneandrade.pdf: 776220 bytes, checksum: 89f7e969fbef687591092b3ded9dd40a (MD5) Previous issue date: 2008-04-30 / Assessing patients with chronic wounds poses a challenge to professionals and doubts still persist concerning characterization of the wound infection status. We believe that the Basic Health Units are in places of reference for the public to submit chronic wounds and should have full attendance and resolution were objectives of this study: characterizing patients with chronic wounds attended as spontaneous demand in the bandage room; characterizing patients chronic wounds regarding the presence of classical signs and additional infection criteria; isolating and identifying aerobic bacteria and fungi in the samples of chronic wounds clinically signaling to infection; verifying strains susceptibility when isolated before antimicrobial agents often used in praxis as well as new antibiotics and analyzing the relationship of local factors with infection status. This is a cross-sectional study, carried out in ambulatory bandage rooms in basic health units with emergency service in the municipality of Goiânia. Data was collected from June to July, in 2007. Data was obtained through the use of structured interviews containing questions about characterization of patients and a check list for the assessment of chronic wounds through the signs and clinical symptoms indicating infection and analysis of wound samples by using swabs in accordance with Levine s technique. After consent and approval of the ethics committee, 46 patients were evaluated and 60 wound samples were assessed. Data bank was organized in Excel table and statistics analysis in SPSS- 15.0. The average age was 55 years, 37 (80.4%) male, 20 (43.5%) belonging to E social class, 23 (50%) retired people having basic sanitation items. 28 (61%) presented venous ulcerated lower limbs, 31 (67.4%) performed the bandage both in the BHU and at home. 45 (75%) out of 60 wounds were infected and 15 (25%) noninfected. Through bivariate analysis we verified an association of the infection status with the following characteristics: width depth of tissular damage, necrotic tissue and exudate amount. Among signs and symptoms, classical ones occurred in a frequency higher than 65% both in the infected and noninfected group. Regarding the additional ones, we verified variance in occurrence in both wound groups. Staphylococcus aureus was predominat in 65% of cases and was sensitive to most antibiotics tested. Among Gram-negative bacteria the most frequent were: Pseudomonas aeruginosa (23%), resistant to amoxylin +clavulanic acid, cefalexin and cefotaxim; Proteus mirabilis (16.6%) and Proteus vulgaris (15.0%), all sensitive to gentamicin, aztreonam, ciprofloxacin, and amicacin. These results indicate the need to structure an integrated net to treat patients with chronic wounds and evidence additional criteria to be employed in the elaboration of service protocols pursuing improvement of quality of assistance given in basic health units. / A avaliação de pacientes com feridas crônicas representa um desafio para os profissionais, e dúvidas, ainda persistem em torno da caracterização do status de infecção, nessas lesões. As Unidades Básicas de Saúde constituem-se locais de referência para a população portadora de feridas crônicas, onde deveriam ter atendimento integral e resolutividade. Objetivos deste estudo: caracterizar os pacientes com feridas crônicas, atendidos como demanda espontânea, na sala de curativos; caracterizar as feridas crônicas dos pacientes atendidos em relação à presença de sinais clássicos e critérios adicionais de infecção; isolar e identificar bactérias aeróbias e fungos das amostras de feridas crônicas, com indícios clínicos de infecção; verificar a susceptibilidade das cepas isoladas, frente aos antimicrobianos freqüentemente utilizados na prática e novos antibióticos, e analisar a relação de fatores locais, com o status de infecção. Trata-se de estudo transversal, realizado em Salas de Curativos Ambulatoriais de Unidades Básicas de Saúde (UBS), com atendimento de urgência do Município de Goiânia. Os dados foram coletados no período de junho a julho de 2007 e obtidos por meio de entrevista com roteiro estruturado, contendo questões de caracterização dos pacientes e de um check-list, para a avaliação das feridas crônicas, por meio dos sinais e sintomas clínicos indicativos de infecção, e análise de amostras de feridas utilizando o swab, mediante técnica de Levine. Após aprovação pelo Comitê de Ética e Consentimento, foram avaliados 46 pacientes, e analisadas amostras de 60 feridas. Os programas computacionais utilizados para organizar e analisar estatisticamente os dados foram: o Excel e o SPSS (versão 15.0), respectivamente. A média de idade foi de 55 anos, 37 (80,4%) eram do sexo masculino, 20 (43.5%) pertenciam à classe social E, 23 (50%) eram aposentados e possuíam itens de saneamento básico, 28 (61%) apresentaram úlceras venosas, localizadas nos membros inferiores, 31 (67,4%) realizavam o curativo nas UBS ou em domicílios. Das 60 lesões, 45 (75%) estavam infectadas e 15 (25%) não infectadas. Mediante análise bivariada, verificaram-se associação com o status de infecção as seguintes características: profundidade da extensão do dano tissular, quantidade de tecido necrótico e exsudato. Dentre os sinais e sintomas, os clássicos ocorreram numa freqüência superior a 65%, tanto no grupo de infectadas quanto não infectadas, e nos adicionais verificou-se variação na ocorrência, em ambos os grupos de feridas. Houve predominância do Staphylococcus aureus em 65% dos casos e a maioria sensível aos antibióticos testados. Entre as bactérias Gram-negativas, as mais freqüentes foram: Pseudomonas aeruginosa (23,3%), resistentes à amoxicilina+ácido clavulânico, cefalexina e cefotaxima; Proteus mirabilis (16,6%) e Proteus vulgaris (15,0%) sensíveis a gentamicina, aztreonam, ciprofloxacino e amicacina. Estes resultados indicam a necessidade de se estruturar uma rede integrada, para o atendimento dos pacientes com feridas crônicas. Também evidenciam critérios adicionais que podem ser empregados na elaboração do protocolo de atendimento, buscando a melhoria da qualidade da assistência prestada nas unidades básicas de saúde.

La modélisation du système musculo-squelettique est un outil permettant l'amélioration des connaissances du fonctionnement biomécanique des structures ostéo-articulaires et musculo- tendineuses. Nos travaux de recherche portent sur le développement d'une méthodologie de modélisation personnalisée, volumique, déformable et à capacité contractile du système musculo- squelettique du membre inférieur, intégrant l'ensemble des outils, le plus possible automatisés, de construction (basée sur l'imagerie médicale), de simulation (en couplage avec un modèle multi-corps dynamique) et d'analyse (comme la cartographie des raideurs locales dans le muscle) nécessaires à leur mise en œuvre dans le cadre d'études orthopédiques / Musculo-skeletal modeling can update our knowledge concerning the biomechanical behavior of the osteoarticular and musculotendinous structures. This research work is focus on the development of methodology and tools for the generation of a personalized model of the lower limb musculoskeletal system, taking account of the deformable and contractile behavior of the muscles. This workflow automatically builds the model dataset (from medical imagery), performs the simulations (coupled with a multibody dynamic model), and offers specific analysis tools (as local stiffness mapping in the active muscle) required for various orthopedic studies

Differences in the lifestyle of various populations may lead to changes in the shape of the long limb bones. This involves a reaction to the degree of mechanical and environmental stress acting upon these bones. Our work examined changes in the shape, proportions and size of the lower limb long bones (femur, tibia) over roughly the past five thousand years, or more precisely from the later phase of the Early Stone Age up to the 20th century. We studied the femurs and tibias of a total 520 adult individuals − 313 males and 207 females − from seven different periods or rather archaeological cultures. Our evaluation was based on the external, linear dimensions of the bones studied. Biological parameters were evaluated in relation to sexual dimorphism and lateral asymmetry. We paid special attention to the degree of flattening of the proximal third of the femoral and tibial shafts. Sexual dimorphism differed in individual populations. We found the least statistically significant parameters of sexual dimorphism in the oldest, Eneolithic, samples. In contrast, both sexes differed in the greatest number of parameters in the Early Middle Ages. Lateral asymmetry was most frequently demonstrated for the width dimensions in the case of the femoral and tibial diaphyses, which are in complete concurrence with...

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At the Ottawa Hospital in Ontario, Canada, clinicians use full body immersion virtual reality to treat a variety of health conditions, including: traumatic brain injuries, post- traumatic stress disorder, acquired brain injuries, complex regional pain syndrome, spinal cord injuries, Guillain-Barré syndrome, and lower limb amputations. The system is shared between military and civilian patient populations. Viewed by clinicians and the system’s designers as a value neutral medical technology, clinical virtual reality’s sights, sounds, movements, and smells reveal cultural assumptions about universal patient experiences. In this dissertation I draw from reflexive feminist research methodologies, visual anthropology and sensory ethnography in a hospital to centre the body in current debates about digital accessibility in the 21st Century. 40 in-depth interviews with practitioners and patients, 210 clinical observations, and film and photography ground research participant experiences in day-to-day understandings of virtual reality at the hospital. In this dissertation I address an ongoing absence of the body as a site of analytical attention in anthropological studies of virtual reality. While much literature in the social sciences situates virtual reality as a ‘post-human’ technology, I argue that virtual reality treatments are always experienced, resisted and interpreted through diverse body schemata. Furthermore, virtual reality cannot be decoupled from the sensitivities, socialities and politics of particular bodies in particular places and times. The Ottawa Hospital’s Computer Assisted Rehabilitation Environment (CAREN) system features a digitally enhanced walk-in chamber, treadmills on hydraulic pistons, surround sound audio, advanced graphics and user feedback utilizing force plates and a dynamic infrared motion capture system. The CAREN system utilizes hardware and software reliant on specific assumptions about human bodies. For example, these assumptions are echoed in depictions of race, gender, class, and indigeneity. Patients using virtual reality technologies can experience more than one disability or health condition at a time, further disrupting the idea of universal user experiences. As clinicians and patients confront the limitations of body normativity in the CAREN system’s interface design, they improvise, resist, and experience virtual reality in ways that defy design agendas, ultimately shaping patient treatments and unique paths to healing and health. / Graduate

Preface: The research about product development of a prosthetic socket was conducted by two students from Mälardalen University, department of Innovation, Design, and Technology. Background: The most recent public survey shows that an estimated 5 million people in China are amputees, out of which a significantly large portion are below-elbow amputees. Sockets sold to below-elbow amputees are equipped with only two surface electromyography sensors, has low comfortability, has problems with perspiration, and a high weight. The current standard for socket manufacturing has not changed in decades. Research Questions: The following research questions have determined the direction of the research: (1) What measurable factors contribute to a convenient and ergonomic feature design in prosthetic socket from the end-user’s perspective? (2) How can the weight and functionality be improved to achieve a prosthetic socket more suited to the end-user, with respect to the existing prosthetic socket? (3) Which material and manufacturing method is suitable for producing cost-effective and customized prosthetic sockets? Research Method: The research was guided by the 5th edition of Product Design and Development by Ulrich & Eppinger (2012) where the product development process described in five of the six phases from planning to test and refinement were utilized. The data collection and analysis techniques performed in this research was guided by Research Methods for Students, Academics and Professionals by Williamson & Bow (2002). Interviews were conducted with five different stakeholders to find specifications of requirements and concretize subjectivism of what defines quality and ergonomics. Implementation: Currently, below-elbow amputees order sockets from orthopedic clinics. The socket was identified as a product of Ottobock. Investigations were made to find optimal solutions to the specification of requirements. Results: The development of a socket concept was designed for additive manufacturing using a multi-jet fusion printer. Analysis: This concept had significant improvements to parameters: higher grade of customizability, 30 % reduced weight, 48 % cost reduction, a new production workflow with 93,5 % automation, and a 69 % reduction in manual work hours. Conclusions: The data of the research strongly indicate existing potentials in enhancing socket design techniques and outputs by implementation of additive manufacturing processes. This can prove to be beneficial for achieving more competitive prosthetics and associated services. / Förord: Denna forskning om produktutvecklingsprocessen av en armprotes genomfördes av två studenter från Mälardalens universitet, avdelningen för innovation, design och teknik. Bakgrund: Den senaste offentliga undersökningen visar att cirka 5 miljoner människor i Kina är amputerade, varav en betydligt stor del är under-armbågsamputerade. Armproteser som säljs till underarmsamputerade individer är utrustade med endast två yt-elektromyografiska sensorer, har låg komfort, har problem med perspiration och hög vikt. Den nuvarande standarden för armproteser har inte förändrats under årtionden. Forskningsfrågor: Följande forskningsfrågor har bestämt riktningen för forskningen: (1) Vilka mätbara faktorer bidrar till en praktisk och ergonomisk funktionsdesign i underarmsproteser ur slutanvändarens perspektiv? (2) Hur kan vikten och funktionaliteten förbättras för att åstadkomma en underarmsprotes som är bättre anpassad för slutanvändaren med avseende på den befintliga underarmsprotesen? (3) Vilket material och tillverkningsmetod är lämpligt för att producera kostnadseffektiva och anpassade underarmsproteser? Forskningsmetod: Forskningsmetoden styrdes av den femte upplagan av Product Design and Development av Ulrich & Eppinger (2012) där produktutvecklingsprocessen är uppdelad i sex faser. I denna forskning användes de fem första faserna från planering till testning och justering. Tekniker för datainsamling och analys som användes i denna forskning styrdes av Research Methods for Students, Academics and Professionals av Williamson & Bow (2002). Intervjuer genomfördes med fem olika intressenter för att hitta kravspecifikationer och för att konkretisera subjektivitet för vad som definierar kvalitet och ergonomi. Implementering:  Underarmsamputerade individer beställer för närvarande armproteser från ortopediska kliniker. Armprotesen identifierades som en produkt av Ottobock. Undersökningar gjordes för att hitta optimala lösningar för kravspecifikationen. Resultat: Konceptutvecklingen av en armprotes utformades för additiv tillverkning med hjälp av en multi-jet-fusion-skrivare. Analys: Det här konceptet hade betydande förbättringar av parametrar: högre grad av anpassningsbarhet, 30 % minskad vikt, 48 % kostnadsreduktion, ett nytt produktionsflöde med 93,5 % automatisering och en 69 % minskning av manuella arbetstider. Slutsatser: Data från denna forskning indikerar att det finns starkt potential för att förbättra designtekniker och utgångar av underarmsproteser genom implementering av additiva tillverkningsprocesser. Detta kan visa sig vara fördelaktigt för att uppnå mer konkurrenskraftiga proteser och tillhörande tjänster.

La Enfermedad Pulmonar Obstructiva Crónica (EPOC), presenta signos y síntomas sistémicos que se han venido explorando desde hace algún tiempo. La presente Tesis Doctoral estudia la disfunción que presentan los músculos respiratorios y periféricos, específicamente el cuádriceps de los pacientes con EPOC. Esta disfunción muscular afecta las actividades de la vida diaria, la tolerancia al ejercicio, limita la calidad de vida y disminuye la expectativa de vida de estos pacientes. Una de las posibles causas de disfunción muscular en los pacientes con EPOC puede ser la pérdida de masa muscular; por eso nos dedicamos a evaluar, los datos antropométricos de los pacientes con EPOC que asistieron durante 2 años a nuestro Laboratorio de Función Respiratoria del Hospital del Mar de Barcelona. La prevalencia de bajo peso en pacientes con EPOC en un hospital con predominante población mediterránea con, índice de masa corporal (IMC) por debajo de 20 Kg/m2, fue de tan sólo 6,6%, cifra que se reducía al 3,1% si el dintel escogido era de 18 Kg/m2. Estas cifras van claramente en oposición a la prevalencia referida en el mundo anglosajón y del norte-centro europeo, que muestra una prevalencia de bajo peso en pacientes con EPOC que oscila entre el 25 y el 35%. Teniendo en cuentas estos datos de baja prevalencia de bajo peso en nuestros pacientes con EPOC, no se explica la alta prevalencia de disfunción muscular en ellos. Por ello evaluamos variables de función muscular en pacientes con EPOC grave, específicamente del músculo cuádriceps y encontramos que los pacientes con EPOC tenían una disminución tanto de la fuerza muscular (43%), como de la resistencia muscular (77%), al compararlos con controles del mismo grupo etáreo.Tratando de profundizar en la causa de la disfunción muscular periférica en los pacientes con EPOC, hicimos a continuación otro estudio donde evaluamos el daño sarcoplásmico y sarcomérico mediante inmunohistoquímica y microscopía electrónica. Este trabajo demostró por primera vez que los pacientes con EPOC presentan mayor daño a nivel del músculo cuádriceps que los controles sanos.Debido a que en la EPOC los músculos periféricos, específicamente los de las extremidades inferiores, pudieran estar afectados por el sedentarismo, decidimos estudiar otras causas de disfunción muscular en un grupo de músculos en que este factor se hallara ausente, como son los músculos respiratorios. Estos mantienen su nivel de actividad normal o incluso aumentada. Para ello tomamos un músculo como el intercostal externo, que es fácilmente accesible a la biopsia, siguiendo un modelo mínimamente invasivo descrito por nuestro grupo. Como en trabajos precedentes ya habíamos valorado el daño sarcomérico, el estrés oxidativo o la actividad enzimática, en esta ocasión el trabajo se centró en la evaluación de la actividad inflamatoria. En él se ha demostrado que las citocinas proinflamatorias TNF-α e IL-6 se encuentran aumentadas en los músculos intercostales externos de los pacientes con EPOC al compararlo con los controles sanos. / Chronic Obstructive Pulmonary Disease (COPD), shows systemic sign and symptoms that have been studied for some time. The present Doctoral Thesis studies the dysfunction shown by the respiratory and peripheral muscles, specifically the quadriceps muscle of patients with COPD. This muscle dysfunction affects the activities of daily living, tolerance to exercise, limits quality of life and diminishes life expectancy of these patients. One of the possible causes of muscle dysfunction in the patients with COPD could be the loss of muscle mass; for that reason we evaluated, the anthropometrics data of the patients with COPD that attended during 2 years our Respiratory Function Laboratory, Hospital del Mar of Barcelona. The prevalence of low weight in patients with COPD in a hospital with a predominantly Mediterranean population with an Body Mass Index (BMI) below 20 Kg/m2, was only 6.6%, a figure that was reduced to 3.1% if the chosen threshold was 18 Kg/m2. These numbers starkly contrast to the prevalence in Northern Europe, with a low weight in patients with COPD raging from 25 to 35%. Considering these data of low prevalence of low weight in our patients with COPD, the high prevalence of muscle dysfunction is not explained. We evaluated variables of muscle function in patients with severe COPD, specifically the quadriceps muscle and we found that the patients with COPD had a decreased muscle strength (43%), and muscle endurance (77%), when comparing with healthy age matched. To study the cause of the peripheral muscle dysfunction in patients with COPD, we began another study where we assessed sarcoplasmic and sarcomeric damage by immunohystochemical methods and electronic microscopy. This work demonstrated for the first time that patients with COPD show greater muscle injury at the quadriceps muscle level that healthy age matched controls.Because in COPD, peripheral muscles, specifically those of the lower limbs, could be affected by sedentarism, we decided to study other causes of muscle dysfunction in a muscle group in which this factor was absent, as they are the respiratory muscles. These maintain their level of normal activity or activity is even increased. For this we chose a respiratory muscle like the external intercostal muscle, that is easily accessible by biopsy, following a minumum invasive model described by our group. As in preceding works of our group we evaluated the sarcomeric damage, oxidative stress or the enzymatic activity, the present work was focused in the inflammatory activity evaluation. We demonstrated that proinflammatory cytokines such as TNF-α and IL-6 are increased in the external intercostal muscles of patients with COPD when comparing with healthy age matched controls.

Ideal prostheses are defined as artificial limbs that would permit physically impaired individuals freedom of movement and independence rather than a life of disability and dependence. Current lower limb prostheses range from a single mechanical revolute joint to advanced microprocessor controlled mechanisms. Despite the advancement in technology and medicine, current lower limb prostheses are still lacking an actuation element, which prohibits patients from regaining their original mobility and improving their quality of life. This thesis aims to design and test a Pneumatic Artificial Muscle that would actuate lower limb prostheses. This would offer patients the ability to ascend and descend stairs as well as standing up from a sitting position. A comprehensive study of knee biomechanics is first accomplished to characterize the actuation requirement, and subsequently a Pneumatic Artificial Muscle design is proposed. A novel design of muscle end fixtures is presented which would allow the muscle to operate at a gage pressure surpassing 2.76 MPa (i.e. 400 psi) and yield a muscle force that is at least 3 times greater than that produced by any existing equivalent Pneumatic Artificial Muscle. Finally, the proposed Pneumatic Artificial Muscle is tested and validated to verify that it meets the size, weight, kinetic and kinematic requirements of human knee articulation.