Introduktion: Amputation som åtgärd vid diabeteskomplikationer och vaskulära sjukdomar har använts sedan 1800-talets mitt. Trots framgångsrik forskning kring dessa sjukdomar förutspås amputation relaterat till diabetes och vaskulära sjukdomar öka i västvärlden. Det ingrepp som en amputation innebär påverkar individen både fysiskt och psykiskt och kan leda till förändrad livskvalitet. Syftet: Var att belysa individens livskvalitet efter amputation av nedre extremitet till följd av diabetes och/eller vaskulära sjukdomar. Metod: En litteraturstudie med Polit och Becks (2012) modell som grund. Cinahl och PubMed var de databaser som användes. Resultatet är en sammanställning av två artiklar från Cinahl och tre artiklar från PubMed, samt fem frisöksartiklar. Artiklarna har granskats och bearbetats för att slutligen sammanställts i tre kategorier samt underkategorier. Resultat: Amputation påverkar livskvaliteten rörande den fysiska och mentala funktionen, rollfunktionen och den sociala funktionen. Försämrad fysisk funktion, besvärande känslor och begränsad självständighet är några av de faktorer som har betydelse för den upplevda livskvaliteten. Amputation och synen på den förändrade kroppsbilden är ytterligare faktorer som spelar in, liksom tillgång eller brist på socialt stöd. Slutsats: Amputation är ett kirurgiskt ingrepp som påverkar människans livskvalitet på ett komplext vis då det berör ett flertal faktorer.  Berörda omständigheter interagerar med varandra och kan leda till bland annat minskad fysisk förmåga, nedstämdhet och begränsad självständighet.

A high powered 4 DOF prosthesis for transfemoral amputees is presented in this paper. The prosthesis utilizes series elastic actuators with high powered hobby grade helicopter motors capable of providing 2880~W of power each for knee and ankle pitch and ankle roll. In addition, a yaw motor with a planetary gearbox combination is used for yaw actuation providing up to 21~Nm of torque. The prosthesis was designed to accommodate a variety of activities including, but not limited to, walking, running, and stair climbing. / Master of Science / A high powered prosthesis for transfemoral amputees is presented in this paper. Four control mechanisms, three of which are in series with springs to reduce the total power requirement of the motors, are used on the prosthesis to provide power to all motions of the leg. The prosthesis is capable of providing powered motion for knee and ankle pitch, ankle roll, and ankle yaw, i.e. ankle rotation from side to side. The prosthesis was designed to handle a variety of activities including, but not limited to, walking, running, and stair climbing.

The purpose of this study was to analyze kinetic and kinematic data of individuals with unilateral transtibial limb loss and the effect different alignments have on the individual’s gait while they walk over uneven terrain. Individuals with lower limb loss are currently having their prostheses dynamically aligned to ensure a satisfactory walking gait on level ground with smooth surfaces, usually in the clinician's office or hallway. This study was looking to determine whether or not current prosthesis alignment procedures are adequate for determining a satisfactory walking gait on non-level and non-smooth terrains as well level smooth surfaces. An effective and efficient walking pattern is necessary to prevent degenerative conditions within the bones, muscles or other tissues of the body, due to compensations of the gait pattern. Sometimes, individuals are able to mask any compensations if their safety is unaffected by their surroundings and they are able to maintain a gait that appears normal or optimal. However, if terrains used on a daily basis present a sense of insecurity, gait compensations could be more problematic to the individual and they need to be addressed and corrected as best they can. This study determined that while there were some changes in gait on the uneven surface, due to the number of subjects it is unclear whether the changes are significant. The individuals showed a decrease in walking speed and step length and an increase in step width. There were also changes in the peak axial force.

Transtibial amputation is a major surgical procedure where both short- and long-term perspectives are important. The surgical method can directly impact stump quality which can affect the prosthetic user’squality of life.  The aim of this scoping review is to summarize and give an overview of the research area of different incision types in relation to prosthetic rehabilitation, to help future researchers and potentially unveil areas where further research is needed. The research question: What is the data available for Different Transtibial Amputation Techniques in Prosthetic Rehabilitation, which was divided into three sub questions. The 6-step framework for scoping reviews by the Joanna Briggs Institute was used to structure the review. From a total of 736 studies screened, 28 were selected and mapped onto 12 different outcome measures. Extensive data were found regarding what amputation method has what surgical outcomes. Areas that appear to have research gaps are dressing types and contractures when contrasted with surgical methods. No study could be found regarding length of hospital stay and the Skew flap method. We conclude that there is a research gap when it comes to patient reported assessments, surveys and qualitative evaluations. / Transtibial amputation är ett större kirurgiskt ingrepp där både kort- och långsiktiga perspektiv är viktiga. Den kirurgiska metoden kan direkt påverka stumpkvalitet vilket kan vidare påverka protesanvändarens livskvalitet. Syftet med denna Scoping Review är att summera och ge en överblick över forskningsområdet inom olika typer av kirurgiska snittföringar i relation till protesrehabilitering för att hjälpa framtida forskare och eventuellt avslöja områden där vidare forskning behövs. Forskningsfrågan var: Vad finns det för data tillgänglig för olika transtibial amputationsmetoder i protesrehabilitering, vilket delades upp i tre delfrågor. Ett sex-stegs ramverk för Scoping Reviews från Joanna Briggs Institutet användes för att strukturera översikten.Av totalt 737 studier som granskades var 28 utvalda och kartlagda till 12 olika utfallsmått.  Omfattande data hittades om vilken amputationsmetod som har vilka kirurgiska resultat. Områden som verkar ha forskningsluckor är postoperativt förband och kontrakturer i kontrast till amputationsmetod. Ingen studie kunde hittas angående längden på sjukhusvistelsen med vriden sidolambå. Vi drar även slutsatsen att det finns en forskningslucka när det gäller patientrapporterade bedömningar, undersökningar och kvalitativa utvärderingar

Transtibial stump volume can change dramatically postoperatively and jeopardise prosthetic fitting. Differences between individuals make it hard to give general recommendations of when to fit with a definitive prosthesis. Measuring the stump volume on every patient could solve this, but most methods for volume assessments are too complicated for clinical use. The aim of this study was to evaluate accuracy and intra- and interrater precision of a method to estimate stump volume from circumferential measurements. The method approximates the stump as a number of cut cones and the tip as a sphere segment. Accuracy was evaluated theoretically on six scanned stump models in CAPOD software and manually on six stump models. Precision was evaluated by comparing measurements made by four CPOs on eight stumps. Measuring devices were a wooden rule and a metal circumference rule. The errors were estimated with intraclass correlation coefficient (ICC), where 0,85 was considered acceptable, and a clinical criterion that a volume error of ±5% was acceptable (5% corresponds to one stocking). The method was accurate on all models in theory but accurate on only four models in reality. The ICC was 0,95-1,00 for intrarater precision but only 0,76 for interrater precision. Intra- and interrater precision was unsatisfying when using clinical criteria. Variations between estimated tip heights and circumferences were causing the errors. The method needs to be developed and is not suitable for stumps with narrow ends. Using a longer rule (about 30 cm) with a set square end to assess tip heights is recommended to improve precision. Using a flexible measuring-tape (possible to disinfect) with a spring-loaded handle could improve precision of the circumferential measurements.

<p>Transtibial stump volume can change dramatically postoperatively and jeopardise prosthetic fitting. Differences between individuals make it hard to give general recommendations of when to fit with a definitive prosthesis. Measuring the stump volume on every patient could solve this, but most methods for volume assessments are too complicated for clinical use.</p><p>The aim of this study was to evaluate accuracy and intra- and interrater precision of a method to estimate stump volume from circumferential measurements. The method approximates the stump as a number of cut cones and the tip as a sphere segment.</p><p>Accuracy was evaluated theoretically on six scanned stump models in CAPOD software and manually on six stump models. Precision was evaluated by comparing measurements made by four CPOs on eight stumps. Measuring devices were a wooden rule and a metal circumference rule. The errors were estimated with intraclass correlation coefficient (ICC), where 0,85 was considered acceptable, and a clinical criterion that a volume error of ±5% was acceptable (5% corresponds to one stocking).</p><p>The method was accurate on all models in theory but accurate on only four models in reality. The ICC was 0,95-1,00 for intrarater precision but only 0,76 for interrater precision. Intra- and interrater precision was unsatisfying when using clinical criteria. Variations between estimated tip heights and circumferences were causing the errors.</p><p>The method needs to be developed and is not suitable for stumps with narrow ends. Using a longer rule (about 30 cm) with a set square end to assess tip heights is recommended to improve precision. Using a flexible measuring-tape (possible to disinfect) with a spring-loaded handle could improve precision of the circumferential measurements.</p>

Unilateral below-knee amputees commonly experience asymmetrical gait patterns and develop comorbidities in their intact (non-amputated) and residual (amputated) legs, with the mechanisms leading to these asymmetries and comorbidities being poorly understood. Prosthetic feet have been designed in an attempt to minimize walking asymmetries by utilizing elastic energy storage and return (ESAR) to help provide body support, forward propulsion and leg swing initiation. However, identifying the influence of walking speed and prosthetic foot stiffness on amputee gait mechanics is needed to develop evidence-based rationale for prosthetic foot selection and treatment of comorbidities. In this research, experimental and modeling studies were performed to identify the influence of walking speed and prosthetic foot stiffness on amputee walking mechanics. The results showed that when asymptomatic and relatively new amputees walk using clinically prescribed prosthetic feet across a wide range of speeds, loading asymmetries exist between the intact and residual knees. However, knee intersegmental joint force and moment quantities in both legs were not higher compared to non-amputees, suggesting that increased knee loads leading to joint disorders may develop in response to prolonged prosthesis usage or the onset of joint pathology over time. In addition, the results showed that decreasing ESAR foot stiffness can increase prosthesis range of motion, mid-stance energy storage, and late-stance energy return. However, the prosthetic foot contributions to forward propulsion and swing initiation were limited due to muscle compensations needed to provide body support and forward propulsion in the absence of residual leg ankle muscles. A study was also performed that integrated design optimization with forward dynamics simulations of amputee walking to identify the optimal prosthetic foot stiffness that minimized metabolic cost and intact knee joint forces. The optimal stiffness profile stiffened the toe and mid-foot while making the ankle less stiff, which decreased the intact knee joint force during mid-stance while reducing the overall metabolic cost of walking. These studies have provided new insight into the relationships between prosthetic foot stiffness and amputee walking mechanics, which provides biomechanics-based rationale for prosthetic foot prescription that can lead to improved amputee mobility and overall quality of life. / text

Yes / Background: Individuals with lower-limb amputation can use running specific prostheses (RSP) that store and then return elastic energy during stance. However, it is unclear whether varying the stiffness category of the same RSP affects spring-mass behaviour during self-selected, submaximal speed running in individuals with unilateral transtibial amputation. Research question: The current study investigates how varying RSP stiffness affects limb stiffness, running performance, and associated joint kinetics in individuals with a unilateral transtibial amputation. Methods: Kinematic and ground reaction force data were collected from eight males with unilateral transtibial amputation who ran at self-selected submaximal speeds along a 15 m runway in three RSP stiffness conditions; recommended habitual stiffness (HAB) and, following 10-minutes of familiarisation, stiffness categories above (+1) and below (-1) the HAB. Stance-phase centre of mass velocity, contact time, limb stiffness’ and joint/RSP work were computed for each limb across RSP stiffness conditions. Results: With increased RSP stiffness, prosthetic limb stiffness increased, whilst intact limb stiffness decreased slightly (p

No description available.

Aim: This review aims to describe the existing evidence base for using elevated vacuum suspension and pin-lock suspension systems in regards to fluctuations of limb volume, balance, effect on gait (spatial and temporal, kinematic, and kinetic data), and in-socket movement (pistoning and transverse forces). Background: There is a growing population with a TT amputation thus there is an increased demand for TT prosthetic solutions. There are a multitude of different suspension methods with different drawbacks and benefits. This review investigates elevated vacuum suspension (EVS) and pin-lock suspension systems. Method: A systematic search was conducted in Medline, PubMed, and Scopus, and included or excluded articles per the eligibility criteria. The chosen studies will be carefully read and critically appraised for their quality of evidence. Results: 13 articles were found that matched the eligibility criteria and aim, 5 articles included pin-lock suspension systems and 9 included EVS systems. 3 looked at limb volume fluctuation, 1 at balance, 4 at in-socket movement (transverse forces and pistoning), and 8 at the quality of gait (temporal and spatial, kinematic, and kinetic). Conclusion: Several of the articles included in this review indicate that EVS results in better performance on balance tests, higher velocity, and a more stable residual limb volume than other suspension systems. Furthermore, it was shown that prosthetic users with an EVS had more normal values in their ROM during gait and less in-socket movement. / Syfte: Den här litteraturöversikten syftar till att beskriva den befintliga evidensbasen för användning av aktivt vakuum-suspension och pinnlås suspension med avseende på fluktuationer i extremitetvolym, balans, effekt på gång (spatial och temporal, kinematisk, och kinetiska data) och rörelse i hylsan (vertikala och tvärkrafter). Bakgrund: Det finns en ökande population som genomgår en transtibial amputation alltså finns en ökad efterfrågan på transtibiala-proteslösningar. Det finns en mängd olika suspensionsmetoder med olika nackdelar och fördelar. Denna recension undersöker eleverad vakuum-suspesnion och pin-lås-suspension. Metod: En systematisk sökning genomfördes i Medline, PubMed och Scopus och inkluderade eller exkluderade artiklar enligt behörighetskriterierna. De valda studierna kommer att läsas noggrant och kritiskt bedömas för deras metodologiska kvalité. Resultat: 13 artiklar hittades som matchade behörighetskriterierna och syftet. 5 artiklar undersökte pin-lås-suspension och 9 undersökte aktivt vakuum-suspension. 3 tittade på volymfluktuationer i extremiteterna, 1 på balans, 4 på rörelse i socket (vertikala och tvärkrafter) och 8 på kvaliteten på gång (temporal och rumslig, kinematisk och kinetisk). Slutsats: Denna litteraturöversikt visade att aktiv vakuum resulterar i att prestera bättre vid balanstester, har högre hastighet och en stabilare extremitet volym än andra suspensionsmetoder. Vidare fann man att protesanvändare med ett aktivt vakuum hade fler normala värden i sitt rörelseomfång under gång och har mindre vertikala krafter i hylsan.