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This thesis explores the NHS Service provision of prosthetic limbs from a patient centred perspective. Amputation is the removal of a limb either for medical reasons or through trauma. The amputated limb can be replaced with a manufactured device to help the patient regain movement and as much function as possible. This device is known as a prosthesis and is given to the patient by the NHS at a Disablement Services Centre (DSC). There has been increasing negative media coverage of the NHS and the service it provides with specific reference to the Postcode lottery which has allegedly become apparent. This research aims to ascertain whether the service being provided at DSCs across the UK is satisfactory to patients and how this service can be improved. The literature surrounding amputation rehabilitation and care pathways is reviewed (Chapter 2). Research philosophies and approaches are discussed (Chapter 3). A countrywide study of NHS Disablement Services Centres was conducted to ascertain how the centres functioned and the differences in service between centres (Chapter 4). The data collected from this study were used to create a questionnaire for amputees to ascertain their opinions on the service they received at their centre (Chapter 5). The data revealed that patients had many problems with the service they received, very few of which could readily be acted upon due to budget restrictions. An investigation into patient s opinions on information provision was conducted as information provision was a problem highlighted by patients that could be influenced by further research (Chapter 6). Data gathered from all three studies were used to produce a proposed clinical pathway for Disablement Services Centres to follow with a new patient (Chapter 7). The proposed pathway was critically evaluated by prosthetists at a clinical conference and improvements to the proposed pathway were made using their suggestions (Chapter 7). The benefits, drawbacks and threats to the use of the proposed pathway were discussed both from the patient and clinical perspective (Chapter 8). The work was completed by overall conclusions and a discussion of further work (Chapter 9).

Made available in DSpace on 2014-12-17T14:57:43Z (GMT). No. of bitstreams: 1 EdsonJAP.pdf: 1427766 bytes, checksum: 2d062c892b501f8f46093e7d7c17a9b2 (MD5) Previous issue date: 2007-08-10 / The manufacturing of above and below-knee prosthesis starts by taking surfac measurements of the patient s residual limb. This demands the making of a cartridg with appropriate fitting and customized to the profile of each patient. The traditiona process in public hospitals in Brazil begins with the completion of a record file (according to law n?388, of July 28, 1999 by the ministry of the health) for obtaining o the prosthesis, where it is identified the amputation level, equipment type, fitting type material, measures etc. Nowadays, that work is covered by the Brazilian Nationa Health Service (SUS) and is accomplished in a manual way being used commo measuring tapes characterizing a quite rudimentary, handmade work and without an accuracy.In this dissertation it is presented the development of a computer integrate tool that it include CAD theory, for visualization of both above and below-knee prosthesis in 3D (i.e. OrtoCAD), as well as, the design and the construction a low cos electro-mechanic 3D scanner (EMS). This apparatus is capable to automatically obtain geometric information of the stump or of the healthy leg while ensuring smalle uncertainty degree for all measurements. The methodology is based on reverse engineering concepts so that the EMS output is fed into the above mentioned academi CAD software in charge of the 3D computer graphics reconstruction of the residualimb s negative plaster cast or even the healthy leg s mirror image. The obtained results demonstrate that the proposed model is valid, because it allows the structura analysis to be performed based on the requested loads, boundary conditions, material chosen and wall thickness. Furthermore it allows the manufacturing of a prosthesis cartridge meeting high accuracy engineering patterns with consequent improvement in the quality of the overall production process / A fabrica??o de pr?teses para amputados de membros inferiores (transfemural e transtibial) exige a confec??o de um cartucho com encaixe adequado e personalizado ao perfil de cada paciente. O processo tradicional de atendimento a pacientes em hospitais p?blicos no Brasil inicia-se com o preenchimento de uma ficha conforme portaria n?388, de 28 de Julho de 1999 do minist?rio da sa?de para obten??o da pr?tese, onde ? identificado o n?vel de amputa??o, tipo de equipamento, tipo de encaixe, material, medidas etc. Atualmente, esses cartuchos s?o fabricados de forma manual atrav?s de instrumentos de baixa precis?o, caracterizando um trabalho bastante rudimentar, artesanal e sem nenhuma acuracidade. Nesta disserta??o prop?e-se o desenvolvimento de uma ferramenta integrada que envolva o CAD, para visualiza??o das pr?teses dos tipos transfemural/transtibial em 3D (OrtoCAD), bem como, o projeto e a constru??o um leitor eletromec?nico (esp?cie de scanner tridimensional), capaz de obter automaticamente e qualitativamente, com menor grau de incerteza as informa??es geom?tricas do coto ou da perna sadia. A metodologia inclui a aplica??o de conceitos de engenharia reversa para gerar computacionalmente a representa??o do coto e/ou a imagem reversa do membro sadio. Os resultados obtidos demonstram que o modelo posposto ? v?lido, pois permite a an?lise estrutural em fun??o do carregamento solicitado e a confec??o de um cartucho de pr?tese atendendo elevados padr?es de acuracidade da engenharia com conseq?ente melhoria na qualidade do processo de fabrica??o

Energy Harvesting, also known as power harvesting or ambient power, is the process of obtaining small amounts of power from secondary sources, such as vibrations, light, temperature variations and even radio-frequency emissions. These systems have been uncommon in personal and wearable electronics in the past, however they are slowly gaining traction. With the increasing sophistication of prosthetic limbs and implants, devices that in some cases require a consistent and reliable power source, the potential field of application for energy harvesting grows wider. This thesis project evaluates whether energy harvesting methods could be implemented in future prosthetic limb designs without significantly affecting weight, user comfort, complexity of design etc., and whether the gains of such an implementation would be worth the effort and cost put into it. For reference the project used the RHEO KNEE® by Össur Hf., a microcontroller controlled prosthetic knee, as a device that such a system could be integrated with. Energy harvesting is still an emerging field and is a long time away from being a viable primary power source for most electronic devices. However, it still might have potential as a supplementary source for extending charge cycles or making smaller (and therefore more lightweight) power cells viable. This master’s thesis project was broad in scope and included 3D-design; mechanical, electrical and embedded software design; and setting up a miniature kinetic power generator as well as a photovoltaic harvesting system. No amputees were available for testing the designs so the system was tested with a 3D-printed model that was moved by hand to simulate the generation process. Due to some incorrect inital assumptions, the final electronic design was not optimal for this kind of system. However, a kinetic generator that harvested power from a modeled heel striking the ground 50 times a minute produced about 23mW of power. 53cm2 of photovoltaic panels produced 42μW of power in an ambient light setting. For comparison, a low-power microcontroller needed about 119μW of power on average to do some simple processing and send Bluetooth transmissions once every two seconds. / Energiinsamling (e. Energy Harvesting), är processen för att erhålla små mängder kraft från sekundära källor, såsom vibrationer, ljus, temperaturvariationer och utstrålning i radiofrekvens. Dessa system har varit ovanliga i hemelektronik och bärbar teknik, men de vinner sakta dragkraft. Med den ökande förfining av proteser och implantat, som i vissa fall kräver en jämn och pålitlig strömkälla, växer det potentiella användningsområdet för energiinsamling. Detta examensarbete utvärderar huruvida energiinsamlingsmetoder skulle kunna implementeras i framtida proteskonstruktioner utan att nämnvärt påverka vikt, användarkomfort, komplexitet i design etc., och om vinsterna med en sådan implementering skulle vara värd ansträngningen och kostnaden. Som exempel använde detta projekt en datoriserad knäprotes av Össur HF, RHEO KNEE®, som exempel på ett system som energiinsamling skulle kunna integreras med. Energiinsamling är fortfarande ett växande forskningsområde och är långt ifrån att en strömkälla för det mesta elektronik.. Det kan ändå ha potential som en kompletterande strömkälla som kan förlänga laddningscykler eller göra mindre (och därför lättare) batterier möjliga. Detta examensarbete var brett i omfattning och inkluderade 3D-design; mekanisk-, elektrisk- och mjukvara-design; och inrättning av en kinetisk kraftgenerator i miniatyr samt ett ljusdrivet energiinsamlingssystem. Inga amputerade var tillgängliga för att testa designen, därför så testades systemet med en 3D-printad modell som rördes för hand för att simulera strömförsörjelseprocessen. På grund av några felaktiga initiala antaganden var den slutliga elektroniska designen inte optimal för denna typ av system. Ändå lyckades en kinetisk generator som använde energiinsamlingsprinciper producera cirka 23mW ström genom en simulerad häl som träffade marken cirka 50 gånger i minuten. 53cm2 solcellspaneler producerade 42μW energi i en ljussatt miljö. Som jämförelse behövde en strömsnål styrkrets i genomsnitt cirka 119μW effekt för att genomföra enkla programprocesser och skicka Bluetooth-överföringar en gång varannan sekund. / Hliðarorkuöflun (e. energy harvesting), sem einnig bætti kalla umhverfisöflun, er ferlið við að fá lítið magn af orku frá óbeinum aflgjafa, svo sem frá hristingi, ljósi, hitabreytingum og jafnvel útvarpsbylgjum. Þessi kerfi hafa verið sjaldgæf í raftækjum hingað til, þó þau eru hægt og rólega að fá hlutdeild. Með nýrri og fágaðri gervilimum og ígræðslum, tæki sem í sumum tilvikum þurfa samfellda og áreiðanlega orkjugjafa, víkkar mögulegt notkunarsvið hliðarorkuöflunar. Þetta lokaverkefni metur hvort aðferðir við hliðarorkuöflun gætu verið notaðar í hönnun gervilima framtíðarinnar án þess að hafa neikvæð áhrif á þyngd, þægilegheit, flóknun hönnunar o.þ.h., og hvort hagur sé í samræmi við framlag og kostnað. Þetta verkefni notar RHEO KNEE® frá Össuri Hf. sem viðmið, sem er gervihné stjórnað af örtölvu. Viðmiðinu er ætlað að sýna notagildi kerfisins. Hliðarorkuöflun er ennþá svið í þróun og er nokkuð í að það geti orðið frumorkugjafi fyrir flest raftæki. Hins vegar þá gæti það enn átt möguleika á að vera aukaorkugjafi til að auka tímalengd hverrar hleðslu eða gera minni og léttari rafhlöður raunhæfari. Þetta meistaraverkefni var viðamikið að því leiti að það fól í sér þrívíddarhönnun; vél-, raf- og hugbúnaðarhönnun; og uppsetningu á hreyfirafal ásamt ljósorkuöflunarkerfi. Engir einstaklingar sem misst hafa fót voru til staðar til að prófa hannanir þessa verkefnis. Þ.a.l. voru þær prófaðar með þrívíddarprentuðum líkönum sem hreyfð voru með handafli til að líkja eftir orkuframleiðsluferlinu. Vegna rangrar upprunalegrar forsendu þá var endanleg rafhönnunin ekki ákjósanleg fyrir slíkt kerfi. Hreyfirafall tengdur við gervihæl sem sló jörðu 50 sinnum á mínútu framleiddi þó 23mW af orku. 53cm2 af ljósorkueiningum framleiddu 42μW af afli í meðal herbergisbirtu. Til samanburðar þá eyðir skilvirk örtölva u.þ.b. 119μW af afli í einfaldri tölvuvinnslu ásamt því að senda Bluetooth sendingu á tveggja sekúnda fresti.