Rehabilitation after Trauma
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
Early mobilization is encouraged soon after surgery and a number of early walking aids (EWA) can be used 5–7 days after surgery. This helps greatly in assessing an amputee’s suitability for later provision of a prosthesis. Prostheses involve a number of connecting components together making the attached body-part: A socketAn interface between socket and stump (e.g., a silicone sleeve)A suspension system to keep the socket and stump togetherAn anatomical joint The choice of prosthesis should be tailored to the receiving patient. Active traumatic amputees tend to have different functional expectations from those house-bound with extensive vascular disease. Successful limb fitting depends on a number of factors, of which the most prominent is the interface between residual limb and prosthesis. If the fit and comfort of the socket are not satisfactory, the prosthesis will not be a success. The components supplied should be those that are consistent with the stage of the patient’s rehabilitation and should become more advanced as rehabilitation progresses.
Valvular Heart Disease
P. Chopra, R. Ray, A. Saxena in Illustrated Textbook of Cardiovascular Pathology, 2013
Mechanical prostheses Several types of mechanical prostheses have been designed and marketed. Essentially, these are comprised of a metal or pyro-phytic carbon-coated graphite frame, silicon ball or tilting disc, and teflon sewing ring. The prototype of the ball and cage mechanical prostheses is the Starr-Edwards valve and that of the tilting disc group is the Bjork-Shiley valve and hinged bileaflet prostheses is the St. Jude prosthetic valve. Prosthetic valves have potentials for various complications. Patients with this device have to be maintained on life-long anticoagulation and therefore they suffer an increased risk of hemolysis. The incidence of this has lessened considerably due to better designing. Dehiscence of sutures may result in paravalvular leak. Ring and surface of the valve can be covered by overgrowth of fibrous tissue (pannus formation) This overgrowth may impede effective functioning or the mechanical prostheses. Infective endocarditis of mechanical prosthesis is of considerable concern. Sutures give way in most cases of infective endocarditis resulting in paravalvular leak and regurgitation of valve. The vegetations may grow and extend to cover/block the valve. Mortality in such instances is high. Thromboembolism is another consequence. Other complications include fracture of the ball within the cage fragments of which may embolise.
Upper and Lower Limb Robotic Prostheses
Pedro Encarnação, Albert M. Cook in Robotic Assistive Technologies, 2017
Form and function are often the first aspects that spring to mind when discussing a prosthetic device. Form includes how the different parts of the device are configured, how they relate to each other, the material used in the construction of the prosthesis, and the cosmetic appearance of these parts (such as color and texture). For example, a prosthesis could be formed from a fiberglass or plastic base that is painted to match the color of the user’s skin, with metal parts concealed under cosmetic rubber liners to simulate the look of regular human tissue. Alternately, a device might be fabricated from black carbon fiber with visible motors and some exposed metal parts or highlighted technology. Some prostheses are painted with custom artwork. Others are sculpted to exactly match the shape and appearance of a user’s nonamputated limb. While form may vary greatly, it is dictated in a large part by the functional and social needs of the user.
Advances in additive manufacturing processes and their use for the fabrication of lower limb prosthetic devices
Published in Expert Review of Medical Devices, 2023
Shaurya Bhatt, Deepak Joshi, Pawan Kumar Rakesh, Anoop Kant Godiyal
Traditionally prostheses are fabricated by assembling various standard components into one assembly that fulfills the required functionality. Some components are made by machining, while some are manufactured using the casting method, which requires a machining process to obtain the finished product. All these processes are not material efficient as raw material is wasted while machining. Moreover, the prostheses fabricated by the traditional method are standard prostheses that are not based on individual requirements and do not provide the utmost fit and comfort to the user. To overcome these shortcomings, the additive manufacturing processes can be used to get the desired fit and comfort as they can provide user-specific outputs. Prosthetic devices are specific to the type of amputation suffered by the person. For example, an above-knee prosthetic limb includes a transfemoral socket, an artificial knee, a pylon, a foot, and a few adaptors to attach these parts into one assembly [43]. A prosthetic device for below-knee amputation would include similar components except for the artificial knee. An above-knee prosthetic device assembly is shown in Figure 3, with components like an artificial knee, a damping device, transfemoral socket, foot, and adaptors. Some of the lower limb prosthesis developed by researchers are given in Figure 4 [3,44–61]. All these devices were developed by traditional methods.
Advances in surgical strategies for prolapse
Published in Climacteric, 2019
A. Giannini, M. Caretto, E. Russo, P. Mannella, T. Simoncini
Reconstruction of a failed pelvic floor can be obtained through re-creation of an anatomical support that resembles as much as possible the original. However, there is no indication for repairing an asymptomatic POP as an isolated procedure where surgical correction is of uncertain benefit and adds perioperative and postoperative risks. The surgical repair techniques are classified as ‘native tissue repair’ when only pelvic organ support tissues are used and as ‘augmented repair’ when some other material (prosthesis or graft) is used to reinforce the defective support system. Prostheses are classified as meshes, implants, and tapes (slings). Grafts are classified as autologous grafts, allografts, and xenografts. Today, synthetic polypropylene mesh is the most commonly used reconstructive material in surgical augmented repair of POP17.
Being “just normal”: a grounded theory of prosthesis use
Published in Disability and Rehabilitation, 2018
Philip Jefferies, Pamela Gallagher, Mark Philbin
Prostheses can have a significant psychological and physical impact on an individual across many domains of life. They can provide a sense of bodily completeness and support gendered identities [4], facilitate activities of daily living, as well as supporting socializing and participation, and gesturing and partaking in rituals [5,6]. Furthermore, studies exploring lower-limb prosthesis use have determined that an improved quality of life is associated with the use of a prosthesis but not with other kinds of assistive technologies (e.g. walking sticks and crutches), indicating that there is something particularly important and distinctive about the use of an artificial limb [7,8]. Despite these benefits, prostheses are imperfect substitutes for biological limbs, and their usage may also lead to difficulties. Issues of comfort and limitations in physical functioning are common complaints, and can leave individuals disappointed with the state of the technology, and this has been linked to device abandonment [9].
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