RESUMEN
Selecting the correct material for each application has always been important. Now, with lattice metamaterials engineers can take advantage of the properties of these metamaterials to best suit a specific application. This paper investigates transtibial lower limb socket stress reduction through the implementation of conformal lattice metamaterials. In this work, a model was obtained with a 3D scanner from a plaster cast taken from a participant with a trans-tibial amputation. Then a 3D socket model was created and two conformal patterns were added to the surface of the socket using nTopology®. Parametric studies to relate the lattice metamaterials constituent elements to their effective structural properties, when such are loaded in-plane and out-of-plane were also included. Pressure test simulations were performed to determine the stresses produced in the sockets. This study concludes with discussion of the results and provides information on how surface conformal patterns can improve socket performance, showing that surface-vertex-centroid patterns increase stiffness and relieve stresses.
Asunto(s)
Miembros Artificiales , Humanos , Diseño de Prótesis , Muñones de Amputación , Amputación Quirúrgica , Tibia/cirugía , Extremidad InferiorRESUMEN
Among the noted disadvantages of prosthesis suspension by flexible liner is the increased rate of perspiration within the socket, which has the potential to cause discomfort, suspension issues, and tissue damage. In recent years, phase change material technology has been adopted for the use in prosthesis liners. These promise to improve temperature control and, consequently, reduce sweating. Previous work has demonstrated that this approach is effective in slowing the temperature increase at the limb-socket interface, but it was not clear how this would translate to clinical outcomes. This study had the aim to compare conventional and phase change material liners regarding prosthesis utilization, physical performance, and patient-reported outcome measures. A randomized double-blind cross-over study design with 6-month intervention periods was used. Of the 42 enrolled participants, only 50% completed the protocol. The high attrition was in large part because of the COVID-19 pandemic that started disrupting daily life and thereby the data collection midway through the study period. The findings indicate that the temperature control liners were, by trend, associated with better prosthesis utilization. The found effects did not reach the level of statistical significance, which is likely a result of the unduly reduced sample size.
Asunto(s)
Miembros Artificiales , COVID-19 , Muñones de Amputación , Estudios Cruzados , Humanos , Pandemias , Diseño de PrótesisRESUMEN
The interface pressure between the residual limb and prosthetic socket has a significant effect on the amputee's mobility and level of comfort with their prosthesis. This paper presents a socket interface pressure (SIFP) system to compare the interface pressure differences during gait between two different types of prosthetic sockets for a transtibial amputee. The system evaluates the interface pressure in six critical regions of interest (CROI) of the lower limb amputee and identifies the peak pressures during certain moments of the gait cycle. The six sensors were attached to the residual limb in the CROIs before the participant with transtibial amputation donned a prosthetic socket. The interface pressure was monitored and recorded while the participant walked on a treadmill for 10 min at 1.4 m/s. The results show peak pressure differences of almost 0.22 kgf/cm2 between the sockets. It was observed that the peak pressure occurred at 50% of the stance phase of the gait cycle. This SIFP system may be used by prosthetists, physical therapists, amputation care centers, and researchers, as well as government and private regulators requiring comparison and evaluation of prosthetic components, components under development, and testing.
Asunto(s)
Muñones de Amputación , Miembros Artificiales , Diseño de Prótesis , Amputación Quirúrgica , Marcha , Humanos , Rendimiento Físico Funcional , Tibia/cirugíaRESUMEN
Preservation of the knee joint has enormous advantages in terms of mobility and rehabilitation of an amputee. Any cause of breakdown requiring revision to an above-knee amputation is a major setback because it reduces the patient's rehabilitative potential. We report a case of intra-arterial thrombolysis use to save a below-knee amputation stump with acute ischemia. A 56-year-old man who sought the emergency department with 1-day history of acute pain on his right below-knee stump. The angiography confirmed popliteal artery occlusion. Pharmacomechanical thrombectomy, with Aspirex (rotational catheter to restore blood flow in occluded vessel, by removing occlusion material from the vessel) and recombinant tissue plasminogen activator, was performed. After 9 years of follow-up the patient remained asymptomatic, capable of independent ambulation with prosthetic limb. Intra-arterial fibrinolysis seems to be a safe and effective treatment for cases of acutely ischemic amputation stump.
Asunto(s)
Muñones de Amputación/irrigación sanguínea , Fibrinolíticos/administración & dosificación , Isquemia/tratamiento farmacológico , Enfermedad Aguda , Muñones de Amputación/diagnóstico por imagen , Muñones de Amputación/patología , Humanos , Infusiones Intraarteriales , Isquemia/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
ABSTRACT Preservation of the knee joint has enormous advantages in terms of mobility and rehabilitation of an amputee. Any cause of breakdown requiring revision to an above-knee amputation is a major setback because it reduces the patient's rehabilitative potential. We report a case of intra-arterial thrombolysis use to save a below-knee amputation stump with acute ischemia. A 56-year-old man who sought the emergency department with 1-day history of acute pain on his right below-knee stump. The angiography confirmed popliteal artery occlusion. Pharmacomechanical thrombectomy, with Aspirex (rotational catheter to restore blood flow in occluded vessel, by removing occlusion material from the vessel) and recombinant tissue plasminogen activator, was performed. After 9 years of follow-up the patient remained asymptomatic, capable of independent ambulation with prosthetic limb. Intra-arterial fibrinolysis seems to be a safe and effective treatment for cases of acutely ischemic amputation stump.
RESUMO A preservação da articulação do joelho tem grandes vantagens para a mobilidade e a reabilitação de um amputado. Qualquer causa que exija revisão para uma amputação acima do joelho é um grande revés, porque reduz o potencial de reabilitação do paciente. O objetivo aqui foi descrever o uso de trombólise intra-arterial para salvar um coto de amputação abaixo do joelho com isquemia aguda. Homem, 56 anos, procurou pronto atendimento de nosso hospital com histórico de 1 dia de dor aguda em seu coto de amputação infrapatelar direito. A angiografia confirmou oclusão da artéria poplítea. Foi realizada trombectomia farmacomecânica com Aspirex (cateter rotativo para restabelecer o fluxo sanguíneo em vasos ocluídos, removendo material de oclusão do vaso) e ativador do plaminogênio tecidual recombinante. Após 9 anos de seguimento, o paciente permanecia assintomático, capaz de deambulação independente com membro protético. A fibrinólise intra-arterial parece ser um tratamento seguro e eficaz para casos selecionados de coto de amputação com isquêmica aguda.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fibrinolíticos/administración & dosificación , Muñones de Amputación/irrigación sanguínea , Isquemia/tratamiento farmacológico , Infusiones Intraarteriales , Enfermedad Aguda , Resultado del Tratamiento , Muñones de Amputación/patología , Muñones de Amputación/diagnóstico por imagen , Isquemia/diagnóstico por imagenRESUMEN
Limb regeneration involves several interrelated physiological processes in which a particular signalling pathway may play a variety of functions. Blocking the function of Wnt/ß-catenin signalling during limb regeneration inhibits regeneration in axolotls (Ambystoma mexicanum). Limb development shares many features with limb regeneration, and Wnt/ß-catenin activation has different effects depending on the developmental stage. The aim of this study was to evaluate whether Wnt/ß-catenin signalling activation during axolotl limb regeneration has different effects when activated at different stages of regeneration. To evaluate this hypothesis, we treated amputated axolotls with a Wnt agonist chemical at different stages of limb regeneration. The results showed that limb regeneration was inhibited when the treatment began before blastema formation. Under these conditions, blastema formation was hindered, possibly due to the lack of innervation. On the other hand, when axolotls were treated after blastema formation and immediately before the onset of morphogenesis, we observed structural disorganization in skeletal formation. In conclusion, we found that limb regeneration was differentially affected depending on the stage at which the Wnt signalling pathway was activated.
Asunto(s)
Muñones de Amputación/inervación , Regeneración , Vía de Señalización Wnt/efectos de los fármacos , Ambystoma mexicanum , Muñones de Amputación/fisiopatología , Animales , Benzodioxoles/farmacología , Proliferación Celular , Pirimidinas/farmacología , Factor de Transcripción SOX9/metabolismoRESUMEN
BACKGROUND: The preservation and functionality of a limb affected by a malformation (such as congenital pseudoarthrosis of the tibia) or a severely mangled lower limb in children, despite modern reconstructive techniques, remains challenging, often eventually requiring amputation to achieve a better outcome. The classical Syme and Boyd procedures are functionally better than transtibial (TT) amputation, but are not feasible for congenital tibial pseudoarthrosis. TT amputation delivers an excellent, effective, and functional stump that usually leads, after prosthetization, to a functional gait. Unfortunately, in some situations, particularly when amputation is performed conventionally, the stump is also associated with complications. Future surgical revisions are often needed, particularly in children, because of stump overgrowth. METHODS: Between 2008 and 2010, three patients diagnosed with congenital pseudoarthrosis of the tibia associated with neurofibromatosis who were indicated for TT amputation with calcaneal flap after failure of all previous surgical reconstructive procedures were selected. The chosen method for osteosynthesis was an external fixator of Ilizarov. RESULTS: At 12 weeks of follow-up, the stump had healed in all three patients, and tibiocalcaneal fusion was achieved without complications. All patients were prosthetized and had an asymptomatic gait. After a minimum follow-up of 6 years, all three cases with the pedicled sensate composite calcaneal flap still had a strong, full weight-bearing surface and have adapted easily to the conventional prosthesis, providing a painless stump with excellent functionality. CONCLUSION: With a 0 rate of needed revisions, all 3 cases with the pedicled sensate composite calcaneal flap preserving the hind foot still have a strong, full weight-bearing surface and have easily adapted to the conventional prosthesis, providing a painless and excellent functional stump that could last a lifetime. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Muñones de Amputación/inervación , Amputación Quirúrgica/métodos , Calcáneo/cirugía , Seudoartrosis/congénito , Tibia/cirugía , Fracturas de la Tibia/congénito , Niño , Femenino , Humanos , Masculino , Dolor , Seudoartrosis/cirugía , Procedimientos de Cirugía Plástica/métodos , Reoperación , Estudios Retrospectivos , Colgajos Quirúrgicos , Fracturas de la Tibia/cirugía , Soporte de PesoRESUMEN
PURPOSE: Loss of a fourth digit below the level of the proximal phalanx results in a weakened grip, loss of skilled movements, and the amputation stump is repeatedly traumatized. Transposition of an adjacent fifth digital ray can improve hand function and cosmetic appearance by closing the gap created by the missing digit. Digital ray amputation is not a commonly performed procedure. However, when performed correctly it can dramatically improve hand function and cosmesis. The aim of this study was to evaluate the functional and aesthetic results of the fifth ray radial translation and intercarpal arthrodesis in mutilating ring finger injuries. MATERIALS AND METHODS: In this retrospective study, nine consecutive patients who sustained mutilating ring finger injury were managed by fourth ray amputation with fifth ray transposition between January 2008 and December 2014. There were six males and three females with a mean age of 30.2 ± 12.2 years (age range, 16-56 years) at the time of surgery who underwent delayed fourth ray amputation with fifth ray transposition (after 14 days of injury). Eight cases had undergone previous surgical interventions: three ORIF using intramedullary K-wire fixation, one failed reimplantation, four debridement and application of split thickness skin graft. Primary skin closure of the amputated finger was not considered as previous surgery (one patient). RESULTS: All patients were followed up for a mean period of 17.1 ± 4.1 months (range, 12-24 months). Grip strength and RAS score improved after fourth ray resection. The postoperative grip strength and RAS (score) were not compromised by the associated hand dominance. CONCLUSION: The following conclusions can be made despite the fact that this was a limited study as well as a retrospective analysis: 1-In technical terms, resection of the fourth ray with transposition of the small finger with a wedge-shaped hamate-capitate arthrodesis secured by screw fixation is easier than metacarpal osteotomy/transposition and less liable to post-operative complications. 2-The results of this study suggest that fourth ray resection and transposition of the small finger with a hamate-capitate arthrodesis restores hand function and cosmetics.
Asunto(s)
Traumatismos de los Dedos/cirugía , Dedos/trasplante , Procedimientos de Cirugía Plástica/métodos , Adolescente , Adulto , Amputación Quirúrgica , Muñones de Amputación/cirugía , Amputación Traumática/cirugía , Femenino , Dedos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
La neurofibromatosis tipo 1 o enfermedad de Von Recklinghausen (NF1) es uno de los desórdenes genéticos heredables más comunes en el hombre. Se presenta el caso de una paciente femenina de 59 años, afecta de neurofibromatosis tipo 1 con antecedentes de amputación supracondílea del miembro inferior izquierdo a la edad de 19 años por elefantiasis, que provocó deformidad total de la extremidad y que acude por presentar deformidad del muñón que le impide ponerse la prótesis para caminar. Se realizaron complementarios y se procedió a realizar la plastia del muñón con evolución favorable. Se presenta este caso por el interés que dimana de su singularidad en la especialidad de Angiología del Hospital Militar Central "Dr. Carlos J. Finlay", donde fue necesaria la intervención quirúrgica con resultados favorables en la rehabilitación de la paciente(AU)
Neurofibromatosis type 1 or Von Recklinghausen disease (NF1) is one of the most common hereditary genetic disorders in human. We present the case of a 59 year female patient, affected by neurofibromatosis type 1. She has a history of supracondylar amputation of the lower left limb at age 19 due to elephantiasis, which caused her total limb deformity. She comes for presenting deformity of her stump that prevents her from putting on the prosthesis to walk. Complementary procedures were performed and the stent plasty was performed with favorable evolution. This case is presented by the interest that arises from its singularity in the specialty of Angiology at "Dr. Carlos J. Finlay" Central Military Hospital, where the surgical intervention was necessary resulting favorably in the patient's rehabilitation(AU)
Asunto(s)
Humanos , Femenino , Neurofibromatosis 1/genética , Neurofibromatosis 1/rehabilitación , Neurofibromatosis 1/cirugía , Muñones de Amputación/cirugía , Antecedentes GenéticosRESUMEN
La neurofibromatosis tipo 1 o enfermedad de Von Recklinghausen (NF1) es uno de los desórdenes genéticos heredables más comunes en el hombre. Se presenta el caso de una paciente femenina de 59 años, afecta de neurofibromatosis tipo 1 con antecedentes de amputación supracondílea del miembro inferior izquierdo a la edad de 19 años por elefantiasis, que provocó deformidad total de la extremidad y que acude por presentar deformidad del muñón que le impide ponerse la prótesis para caminar. Se realizaron complementarios y se procedió a realizar la plastia del muñón con evolución favorable. Se presenta este caso por el interés que dimana de su singularidad en la especialidad de Angiología del Hospital Militar Central Dr. Carlos J. Finlay, donde fue necesaria la intervención quirúrgica con resultados favorables en la rehabilitación de la paciente(AU)
Neurofibromatosis type 1 or Von Recklinghausen disease (NF1) is one of the most common hereditary genetic disorders in human. We present the case of a 59 year female patient, affected by neurofibromatosis type 1. She has a history of supracondylar amputation of the lower left limb at age 19 due to elephantiasis, which caused her total limb deformity. She comes for presenting deformity of her stump that prevents her from putting on the prosthesis to walk. Complementary procedures were performed and the stent plasty was performed with favorable evolution. This case is presented by the interest that arises from its singularity in the specialty of Angiology at Dr. Carlos J. Finlay Central Military Hospital, where the surgical intervention was necessary resulting favorably in the patient's rehabilitation(AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Angiografía/métodos , Neurofibromatosis 1/etiología , Muñones de Amputación/cirugía , Angiografía/métodosRESUMEN
Los neuromas de muñón son causa de dolor intenso de difícil control. El bloqueo neurolítico es una alternativa en el tratamiento, y el uso de la ultrasonografía se impone para garantizar la efectividad del proceder. En este reporte de caso se describe la realización de la neurolisis con alcohol absoluto de varios neuromas recidivantes en un muñón de miembro superior, guiados por ultrasonido, en un paciente con dolor crónico que no resuelve con tratamiento médico(AU)
Stump-neuromas cause difficult deep pain control. Neurolytic block is an alternative treatment, and ultrasound guarantee the certainty of the procedure. This case report describes the realization of neurolysis with total alcohol of various stump-neuromas, guided by ultrasound, in a patient with chronic pain that don´t solve with medic treatment(AU)
Asunto(s)
Humanos , Masculino , Anciano , Bloqueo Neuromuscular/efectos adversos , Neuroma/terapia , Muñones de Amputación , Dolor Crónico/terapia , Ultrasonografía , Satisfacción del PacienteRESUMEN
Los neuromas de muñón son causa de dolor intenso de difícil control. El bloqueo neurolítico es una alternativa en el tratamiento, y el uso de la ultrasonografía se impone para garantizar la efectividad del proceder. En este reporte de caso se describe la realización de la neurolisis con alcohol absoluto de varios neuromas recidivantes en un muñón de miembro superior, guiados por ultrasonido, en un paciente con dolor crónico que no resuelve con tratamiento médico.
Stump-neuromas cause difficult deep pain control. Neurolytic block is an alternative treatment, and ultrasound guarantee the certainty of the procedure. This case report describes the realization of neurolysis with total alcohol of various stump-neuromas, guided by ultrasound, in a patient with chronic pain that don´t solve with medic treatment.
Asunto(s)
Humanos , Masculino , Anciano , Ultrasonografía/estadística & datos numéricos , Satisfacción del Paciente , Bloqueo Neuromuscular/efectos adversos , Dolor Crónico/terapia , Muñones de Amputación , Neuroma/terapiaRESUMEN
Nas amputações mais distais da ponta dos dedos, o reimplante microcirúrgico pode não ser praticável. Nestes casos, o enxerto composto oferece os melhores resultados funcionais e estéticos, sendo, porém, incerta a sua reintegração. Várias técnicas foram aventadas para melhorar a sobrevida do enxerto volumoso, basicamente diminuindo o seu volume, associando ou não um retalho cutâneo. Outras técnicas criam uma superfície adicional de contato para difusão plasmática, o "bolso subcutâneo", sem diminuir o volume do enxerto composto, com altas taxas de sucesso. O presente artigo apresenta um caso de amputação da ponta distal do dedo mínimo (zona I de Ishikawa) numa criança de 2 anos de idade. Impossível de reimplante microcirúrgico, a reintegração foi feita com enxerto composto do coto amputado, sem desbridamento, e com a criação de uma nova superfície de contato para difusão plasmática, na extremidade distal do coto enxertado, no plano dérmico da região hipotênar, aumentando assim a área de contato e diminuindo a distância radial da difusão plasmática no enxerto composto. Doze dias após, esse contato adicional foi separado e ambas as superfícies apresentaram sangramento. A reintegração foi total, com mínimas cicatrizes no dedo e na região hipotênar. Uma breve revisão bibliográfica foi feita e discutidos os conceitos cirúrgicos, assim como os fatores que influenciam na sobrevida do enxerto composto. Na área receptora, o plano anatômico mais adequado e melhor vascularizado, para o contato adicional com o enxerto, necessita ser determinado.
In more-distal amputations of the fingertips, microsurgical replantation is not feasible. For these cases, composite graft provides the best functional and aesthetic results. However, its reintegration is uncertain. Several techniques have been proposed to improve bulky graft survival by basically reducing its volume, regardless of whether a skin flap is connected. Other techniques create an additional contact surface for plasmatic diffusion, the so-called subcutaneous pocket, without reducing the composite graft volume and yielding high success rates. This article presents a case of amputation of the distal tip of the fifth digit (Ishikawa zone I) of a 2-year-old child. Because of the impossibility of microsurgical replantation, a composite graft was used to reintegrate the amputated stump, without debridement, by creating a new contact surface for plasmatic diffusion at the distal end of the grafted stump, on the dermal plane in the hypothenar region, thereby increasing the contact area and decreasing the radial distance for the plasmatic diffusion of the composite graft. Twelve days later, the additional contact was separated and both surfaces presented bleeding. Full reintegration occurred with minimal scarring of the finger and hypothenar region. A brief literature review was conducted, discussing surgical concepts and factors that influence composite graft survival. The most appropriate and best vascularized anatomic plane for additional contact with the graft in the recipient area needs to be determined.
Asunto(s)
Humanos , Masculino , Preescolar , Historia del Siglo XXI , Reimplantación , Niño , Procedimientos de Cirugía Plástica , Falanges de los Dedos de la Mano , Aloinjertos Compuestos , Traumatismos de los Dedos , Amputación Quirúrgica , Muñones de Amputación , Reimplantación/métodos , Procedimientos de Cirugía Plástica/métodos , Falanges de los Dedos de la Mano/cirugía , Aloinjertos Compuestos/cirugía , Traumatismos de los Dedos/cirugía , Dedos , Dedos/cirugía , Amputación Quirúrgica/métodos , Muñones de Amputación/cirugíaRESUMEN
Knowledge of the general characteristics and physical condition that keeps the transfemoral amputation stump to select and adapt appropriate type of prosthesis to restore a walking pattern amputee patient acceptable and useful design parameters set to propose new prosthetic systems. In this paper, the degree of difference between the volumes of the limb stump and healthy as well as morphological features occurred more frequently in the stumps of transfemoral amputees who were treated at the Laboratory of Orthotics and Prosthetics (LOP), Instituto Nacional de Rehabilitación (INR) in 2008. It captured all patients with unilateral transfemoral amputation left and right, over 18 years old, both sexes, use of hearing candidates were evaluated clinically and took three measurements of the circumferences at different wavelengths and the limb stump healthy, were calculated volumes of both sides using the mathematical model of the truncated cone and analyzed in three groups according to the level of amputation (proximal, middle and distal third). We obtained 49 patients, 39 men and 10 women, the difference stump volume compared to healthy limb volume per group were: 44.9% proximal third, middle third and distal 26.5%, 21.1%, the frequency of diagnostic data showed a stump right transfemoral amputees, due to metabolic, without use of prostheses, the most common morphological features indicate that the stump has a conical shape and size distal third, whose tissue is semi-flaccid consistency, the scar is not adhered to deep planes and shows a negative tinel, the mattress soft tissue is 2.15 ± 1.3 cm and physically presents a force level 4 in the clinical rating scale Daniels. The data are consistent with other studies comparing the percentage of the volume change with the percentages of reduced diameters transfemoral stump muscle, likewise agrees most amputees incidence of diabetes mellitus with other studies, cataloging it eat first cause amputation. The general description developed transfemoral stump-served in the INR will help in the process of manufacture of prostheses and prosthetic design new systems that you attend these needs.
Asunto(s)
Muñones de Amputación , Amputados , Miembros Artificiales , Cicatriz/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Diseño de PrótesisRESUMEN
Prosthesis-integrated sensors are appealing for use in clinical settings where gait analysis equipment is unavailable, but accurate knowledge of patients' performance is desired. Data obtained from load cells (inferring joint moments) may aid clinicians in the prescription, alignment, and gait rehabilitation of persons with limb loss. The purpose of this study was to assess the accuracy of prosthesis-integrated load cells for routine use in clinical practice. Level ground walking of persons with transtibial amputation was concurrently measured with a commercially available prosthesis-integrated load cell, a 10-camera motion analysis system, and piezoelectric force plates. Ankle and knee flexion/extension moments were derived and measurement methods were compared via correlation analysis. Pearson correlation coefficients ranged from 0.661 for ankle pronation/supination moments to 0.915 for ankle flexion/extension moments (P < .001). Root mean squared errors between measurement methods were in the magnitude of 10% of the measured range and were explainable. Differences in results depicted differences between systems in definition and computation of measurement variables. They may not limit clinical use of the load cell, but should be considered when data are compared directly to conventional gait analysis data. Construct validity of the load cell (ie, ability to measure joint moments in-situ) is supported by the study results.
Asunto(s)
Muñones de Amputación/fisiopatología , Articulación del Tobillo/fisiopatología , Miembros Artificiales , Articulación de la Rodilla/fisiopatología , Manometría/instrumentación , Transductores , Caminata , Adulto , Anciano , Simulación por Computador , Diseño de Equipo , Análisis de Falla de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Integración de Sistemas , TorqueRESUMEN
In the 2012 Paralympic 100 m and 200 m finals, 86% of athletes with a unilateral amputation placed their unaffected leg on the front starting block. Can this preference be explained biomechanically? We measured the biomechanical effects of starting block configuration for seven nonamputee sprinters and nine athletes with a unilateral amputation. Each subject performed six starts, alternating between their usual and unusual starting block configurations. When sprinters with an amputation placed their unaffected leg on the front block, they developed 6% greater mean resultant combined force compared with the opposite configuration (1.38 ± 0.06 vs 1.30 ± 0.11 BW, P = .015). However, because of a more vertical push angle, horizontal acceleration performance was equivalent between starting block configurations. We then used force data from each sprinter with an amputation to calculate the hypothetical starting mechanics for a virtual nonamputee (two unaffected legs) and a virtual bilateral amputee (two affected legs). Accelerations of virtual bilateral amputees were 15% slower compared with athletes with a unilateral amputation, which in turn were 11% slower than virtual nonamputees. Our biomechanical data do not explain the starting block configuration preference but they do explain the starting performance differences observed between nonamputee athletes and those with leg amputations.
Asunto(s)
Muñones de Amputación/fisiopatología , Miembros Artificiales , Rendimiento Atlético , Pie/fisiopatología , Pierna/fisiopatología , Postura , Carrera , Adolescente , Adulto , Simulación por Computador , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Esfuerzo Físico , Valores de Referencia , Estrés Mecánico , Adulto JovenRESUMEN
Investigar como a enfermagem enfrenta o cuidado ao paciente submetido à amputação de extremidades e quais as ações que contribuem para reabilitação após a alta hospitalar. Método: estudo qualitativo, análise temática. Questões norteadoras: Como a enfermagem enfrenta o cuidado ao paciente com amputação? Os cuidados durante a hospitalização podem contribuir para reabilitação após a alta hospitalar? Coleta com entrevistas gravadas, com 10 profissionais da equipe de enfermagem de uma rede hospitalar pública, Porto Alegre/RS. Porto Alegre/RS. Resultados: na análise emergiram as duas categorias: características dos pacientes amputados; A equipe de enfermagem frente ao cuidado do paciente amputado. Conclusão: a criação de protocolo sistematizado de atendimento e a revisão do sistema de suporte no pós-alta, pode contribuir para a reabilitação da pessoa amputada.
Investigate how nursing care faces the care to the patient with amputation of the extremities and which actions contribute for the re-habilitation after the hospital discharge. Method: qualitative study and thematic analysis. Guiding questions: How does nursing face the care to the patient with amputation? Can the care given during the hospitalization contribute for the re-habilitation after the hospital discharge? Collection with recorded interviews, signature of free and cleared up consent statements, in October 2011, with 10 professionals of the nursing staff from a public hospital network, Porto Alegre-RS. Results: two categories derived from the analysis: Characteristics of the amputated patients; The nursing staff facing the care to the amputated patient. Conclusion: the creation of a systematized attendance protocol and the revision of the support system in the post-discharge can contribute for the amputated subject re-habilitation.
Investigar como la enfermería enfrenta el cuidado al paciente sometido a amputación de extremidades y las acciones que contribuyen para la rehabilitación tras el alta hospitalaria. Método: estudio cualitativo, análisis temático. Cuestiones orientadoras: ¿Cómo la enfermería enfrenta el cuidado al paciente con amputación? ¿Pueden los cuidados durante la hospitalización contribuir para la rehabilitación tras el alta hospitalaria? Recolección con entrevistas grabadas, firma de declaraciones de consentimientos libres y esclarecidos, en octubre 2011, con 10 profesionales del equipo de enfermería de una red hospitalaria pública, Porto Alegre-RS. Resultados: del análisis surgieron dos categorías: Características de los pacientes amputados; El equipo de enfermería frente al cuidado del paciente amputado. Conclusión: creación de protocolo sistematizado de atendimiento y la revisión del sistema de.
Asunto(s)
Masculino , Femenino , Humanos , Amputación Traumática , Amputación Quirúrgica/enfermería , Muñones de Amputación , Atención de Enfermería , Hospitalización , RehabilitaciónRESUMEN
O edema no coto é umas das complicações mais comuns após uma amputação e pode ser reduzido com o enfaixamento elástico, sendo controlado por medidas da circunmetria, utilizando-se fita métrica. A protetização precoce e a prevenção de contraturas são prioridades na reabilitação. Objetivo: Avaliar as medidas da circunmetria do coto de amputados transtibiais, após o período pré-protetização e pós-protetização. Método: Foram incluídos sete pacientes amputados transtibiais, com média de idade de 54 anos. Foram consideradas três medidas da circunmetria: medida 1 (durante a avaliação da Fisiatria), medida 2 (no 1º dia com prótese - período pré-protetização) e medida 3 (após 12 semanas de uso de prótese - período Pós-Protetização). Resultados: Os dados mostraram a variação das medidas da circunmetria dos cotos dos pacientes, tanto no período pré-protetização, como no pós-protetização. Conclusão: O período pré-protetização, com o uso de enfaixamento elástico e realização de exercícios, assim como o pós-protetização, com o treino de marcha com prótese, são capazes de alterar a circunmetria do coto. Sugere-se a confecção de uma prótese provisória até a estabilização das medidas do coto para posteriormente confeccionar a prótese definitiva.
Stump's edema is one of the most common complications after amputation and can be reduced wearing elastic bandages, being controlled by circumference measurements using a tape measure. Early prosthetic fitting and prevention of contractures are priorities in the rehabilitation. Objective: To evaluate the circumference measurements of the stump of transtibial amputees, before and after prosthetic periods. Method: Seven patients with transtibial amputation and an average of 54 years old were included in the study. We considered three measures of circumference: measure 1 (during the evaluation of the Physiatry), measured 2 (on the first day with prosthesis - Pre-fitting period), and measured 3 (after 12 weeks using prosthesis - Post-fitting period). Results: The data showed variation on circumference measurements of the stumps on both Pre-fitting and Post-fitting periods. Conclusion: The Pre-fitting period, with the use of elastic bandages and exercises, as well as the Post-fitting, with gait training with prosthesis, are able to change the stump circumference. We suggest creating a temporary prosthesis until the measurements of the stump are stabilized for further fabricate the definitive prosthesis.
Asunto(s)
Humanos , Miembros Artificiales , Extremidad Inferior/patología , Muñones de Amputación , AmputadosRESUMEN
INTRODUCTION: Severe lesions in the facial nerve may have extensive axonal loss and leave isolated stumps that impose technical difficulties for nerve grafting. METHODS: We evaluated bone marrow stem cells (BMSC) in a silicone conduit for rat facial nerve regeneration from isolated stumps. Group A utilized empty silicone tubes; in groups B-D, the tube was filled with acellular gel; and, in groups C and D, undifferentiated BMSC (uBMSC) or Schwann-like cells differentiated from BMSC (dBMSC) were added, respectively. Compound muscle action potentials (CMAPs) were measured, and histology was evaluated. RESULTS: Groups C and D had the highest CMAP amplitudes. Group C had shorter CMAP durations than groups A, B, and D. Distal axonal number and density were increased in group C compared with groups A and B. CONCLUSIONS: Regeneration of the facial nerve was improved by both uBMSC and dBMSC in rats, yet uBMSC was associated with superior functional results.