Professional situation of prosthetics and orthotics recent graduates in ESTeSL

The career of prosthetics and orthotics in Portugal have a recent formative path: need to investigate the employability and employment of the graduates in Prosthetic and Orthotics (P&O) in ESTeSL between the academic years of 2004/05 and 2012/13; approaching to socio-demographic data and also academic and professional path. The questionnaire was applied to the P&O professional population graduated in ESTeSL. The results had been important to observe the future perspectives trends for the profession.

Foot orthotics in the treatment of lower limb conditions: A musculoskeletal physiotherapy perspective

Orthotic therapy is frequently advocated for the treatment Of musculoskeletal pain and injury of the lower limb. The clinical efficacy, mechanical effects, and Underlying mechanism of the action of foot orthotics has not been Conclusively determined making it difficult for practitioners to agree on a reliable and valid clinical approach to their application and indeed even their fabrication. This problem is compounded by evidence suggesting that the most commonly used approach for orthotic prescription, the (Biomechanical Evaluation of the Foot. Vol. 1. Clinical Biomechanics Corporation, Los Angeles, 1971) approach, has poor validity and many of the associated clinical measurements of that approach lack adequate levels of reliability. This paper proposes a new approach that is based on two key elements. One is the identification, verification and quantification of physical tasks that serve as client specific outcome measures. The second is the application of specific physical manipulations during the performance of these physical tasks. The physical manipulations are selected on the basis of motion dysfunction and their immediate effects on the client specific outcome measures serve as the basis to making an informed decision on the propriety of using orthotics in individual clients. The motion dysfunction also guides the type of orthotic that is applied. Practical case examples as well Lis generic and specific guidelines to the application of this clinical assessment process and orthotics are provided in this paper. (C) 2004 Published by Elsevier Ltd.

Antipronation taping and temporary orthoses - Effects on tibial rotation position after exercise

Abnormal lower-limb biomechanics-in particular, abnormal pronation of the subtalar joint with concomitant increased internal rotation of the tibia-is one of the major causes of overuse injuries of the lower limb. A randomized, controlled, within-subjects research design (N = 14) was used to investigate the effect of a temporary felt orthosis and an antipronation taping technique to control the transverse tibial rotation position immediately after application and after each of two 10-minute periods of exercise. The results showed that the taping technique was superior to both the orthosis and no intervention in controlling tibial rotation position immediately after application and after 10 minutes of exercise. After 20 minutes of exercise, neither the tape nor the orthosis was significantly superior to the control; however, the trends suggested that some residual control was maintained. Future studies are needed to determine the amount of foot pronation control required to relieve symptoms in a symptomatic population in order to determine the clinical effectiveness of these treatment methods.

Study and comparison of physiological response with Harmony® suspension system and suspension with pin

The purpose of this study is a cross-qualitative and quantitative gait analysis in 3 traumatic unilateral amputees using prosthesis with pin suspension compared to the use of prosthesis with a high vacuum suspension, the Harmony® system. In Portugal, there aren’t many studies made in the field of orthotic and prosthetic and knowledge about the number of amputees in the country. The only know is that the major cause of lower limb amputation is diabetes mellitus, being the most affected population the older age groups. The combination of technological developments with daily needs of the amputees is becoming more and more important for they better quality of life. This work was done during the curricular unit “Investigation in Prosthetics and Orthotics” class, in the 4th year of Health Technology School of Lisbon, in Portugal. This study analyzes if the change of suspension in transtibial prosthesis will influence some physiological response in amputees.

Perceção dos riscos ocupacionais em laboratórios de ortoprotesia na região de Lisboa e Vale do Tejo

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

Estudo de caso de malformação congénita, com quantificação do êmbolo em 4 sistemas de suspensão para próteses endosqueléticas transtibiais com encaixe TSB

Introdução – O efeito de êmbolo é um dos principais problemas relacionados com a eficácia de uma prótese. Uma diminuição do mesmo pode levar a uma marcha mais natural através do aumento da propriocetividade. Objetivos – Verificar se existe diferença de valores do efeito de êmbolo entre vários sistemas de suspensão para próteses transtibiais com a utilização de Liners e testar a aplicação de testes de imagiologia na análise da melhor solução protésica para um determinado indivíduo. Metodologia – Foi obtida uma radiografia da prótese em carga na posição ortostática, mantendo o peso do indivíduo igualmente distribuído pelos dois pés. Seguidamente foi realizada outra radiografia no plano sagital com o joelho com 30° de flexão, com a prótese suspensa e um peso de 5kg aplicado na extremidade distal da mesma durante 30 seg. Através destes dois exames efetuaram-se as medições do êmbolo para cada tipo de sistema de suspensão. Resultados – Dos quatro sistemas estudados apenas três apresentam valores de êmbolo, visto que um dos sistemas não criou suspensão suficiente para suportar o peso colocado na extremidade distal da prótese. Através das medições realizadas nos exames imagiológicos dos três sistemas pudemos encontrar variações de efeito de êmbolo que vão dos 47,91mm aos 72,55mm. Conclusão – Através da realização do estudo imagiológico verificaram-se diferenças a nível do efeito de êmbolo nos vários sistemas de suspensão, provando que esta é uma ferramenta viável na avaliação do mesmo. Também através da análise dos resultados ficou notório que o sistema de suspensão Vacuum Assisted Suspention System (VASS) é o que apresenta menos êmbolo.

Choosing best components for an amputee: a methodology for the best decision-making

The harmony between the stump and the prosthesis is critical to allow it to fulfill its function enabling an efficient gait. A well fitted socket, with an efficient and comfortable suspension, allows the amputee to continue their daily living activities, maintaining the stump functional, making this correlation between socket and suspension very important in the functionality of the prosthesis, mobility and overall satisfaction with the device. Of our knowledge, the quantitative correlation between all of these factors as not yet been assessed. Aim of study: Verify and confirm the process of decision-making for four different trans-tibial prostheses with suspension systems: Hypobaric(A), PIN(B), Classic Suction(C) and Vacuum Active –VASS(D) according data provided by gait efficiency (mlO2/kg/m) imagiology (pistonning) and amputee perception.

Breve caracterização da situação profissional dos licenciados em ortoprotesia pela ESTeSL entre 2004/2005 e 2012/2013

Introdução – Atualmente, devido à elevada taxa de desemprego e à emigração de jovens licenciados, estes veem a carreira e o futuro profissional comprometidos no seu país de origem. Deste modo, a existência de uma reflexão sobre a sua situação profissional poderá clarificar o futuro dos estudantes e recém-licenciados da área de ortoprotesia. Objetivos – Quantificar a situação profissional dos licenciados em ortoprotesia pela Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL) e criar uma ferramenta de reflexão sobre as perspetivas profissionais futuras. Metodologia – Estudo quantitativo: aplicação de um questionário fechado online, através da plataforma LimeSurvey® ao universo dos ortoprotésicos licenciados na ESTeSL. Resultados/Discussão – A maioria dos licenciados é jovem e do sexo feminino e uma minoria possui ou está em formação pós graduada (17%). Dos inquiridos, a maioria encontra-se empregada na área da ortoprotesia (78,3%) e a taxa de desemprego situa-se em 8,7%. Constata-se uma mobilidade geográfica para o distrito de Lisboa, quer para estudos como posteriormente para o local de emprego. Conclusão – A elevada taxa de desemprego verificada nos jovens licenciados em Portugal não parece ter um impacto direto na população analisada, uma vez que a taxa de desemprego obtida e a duração da procura do primeiro emprego obtidas são ambas reduzidas; contudo a, taxa de desemprego é semelhante à de outros cursos das tecnologias da saúde. Registe-se a carência de investimento em formação pós-graduada ou de complementos de formação após a licenciatura.

Análise funcional do design das órteses para rizartrose

The purpose of this paper is to identify the utilization of two models of orthotics used in the conservative treatment of rizartrose in patients/consumers that were referred by the medical clinic to the LAI (Laboratory of Integrated Accessibility). It describes this group s perception related to the functional aspects of the two models, evaluates the value of the product attributed by the patient/consumer and describes the importance attributed to each model. The research s objective consists in identifying which model this is preferred from the point of view by the patients that use either the dorsal or ventral models used in the conservative treatment of rizartrose . This work is then based on the exploratory research through the investigation of the bibliography available and in the research field. The research field used the case study methodology to investigate the phenomenon in the real context. The data were collected using a patient questionnaire during two times after the use of the dorsal orthotic and after the use of the ventral orthotic. The questionnaire was used to identify the relationship between the patients/consumers and the two different types of orthotics. A general descriptive analysis was used in order to verify the patient s abilities executing certain activities daily living using the dorsal and ventral orthotics, the product s functional aspects and its value from the patient s/consumer s point of view. The results show that the preference for the dorsal or ventral models is determined by the individual needs of each person. The results also show that other variables, such as the use of the orthotic on the dominant or non-dominant hand, play a role in the preferred model by the patient/consumer and need to be further investigated

Implant-retained finger prosthesis with modified retention system

Background: Amputations affect both the physical and the psychological aspects of an individual, causing significant impact on self-esteem. The main causes of finger amputations are work-related accidents with dangerous machinery, road traffic accidents, and animal bites, as well as systemic diseases such as diabetes. This report aims to describe a simple technique for fabrication of implant-retained finger prosthesis with a modified base of the retention system.Case Description and Methods: The O-Ring retention system was used with a modified hexagon-shaped base and a metallic capsule adapted to the acrylic resin to attach the prosthesis to the implant.Findings and Outcomes: The prosthesis was made with silicone, and after osseointegration, it was installed without complications, leading to a patient satisfied with the end result and encouraged to return to social life.

Wearable soft robotic device for post-stroke shoulder rehabilitation: identifying misalignments

Stroke is the leading cause of long-term disability in the United States, affecting over 795,000 people annually. In order to regain motor function of the upper body, patients are usually treated by regular sessions with a dedicated physical therapist. A cost-effective wearable upper body orthotics system that can be used at home to empower both the patients and physical therapists is described. The system is composed of a thin, compliant, lightweight, cost-effective soft orthotic device with an integrated cable actuation system that is worn over the upper body, an embedded limb position sensing system, an electric actuator package and controller. The proposed device is robust to misalignments that may occur during actuation of the compliant brace or when putting on the system. Through simulations and experimental evaluation, it was demonstrated i) that the soft orthotic cable-driven shoulder brace can be successfully actuated without the production of off-axis torques in the presence of misalignments and ii) that the proposed model can identify linear and angular misalignments online.

Barns intryck av omgivningen på en ortopedteknisk avdelning : - En kvalitativ studie om hur barn uppfattar miljön och mötet på en ortopedteknisk avdelning

Bakgrund: För att uppnå en god barnanpassad vård inom ortopedteknik krävs information om hur barn uppfattar mötet på en ortopedteknisk avdelning. Genom att ta del av barns tankar, åsikter och förslag kan verksamheter i framtiden lättare argumentera för exempelvis hur lokaler bör inredas och hur man bör bemöta barn.   Syfte: Syftet med denna studie är att undersöka hur barn upplever mötet på en ortopedteknisk avdelning i avseendet vårdmiljö och möte med ortopedingenjören.   Metod: En kvalitativ metod där deltagarna får rita och berätta kallad “Draw and tell” och åtta intervjuer med barn mellan 6 till 12 år om deras upplevelse efter besöket hos en ortopedingenjör genomfördes. Intervjuerna transkripterades och en innehållsanalys genomfördes.   Resultat: Vissa gemensamma faktorer hittades i intervjuerna så som att det ansågs att det samtalades för mycket utan att engagera barnet samt att aktiviteter som fanns sågs som bra då det kunde bli lite väntan under besöket. Det fanns flera förslag på andra aktiviteter som önskades under väntan och speglade barnens egna intressen så som datorspel och böcker.   Slutsats: Denna studie visar att det som ortopedingenjören är viktigt att engagera barnen vid mötena samt att aktiviteter finns till hands under långa väntetider.   Nyckelord: Barns upplevelser, ortopedteknik, ortopedingenjör, bemötande, miljö

Estudo comparativo da estereopsia com três testes diferentes: TNO®, Fly Stereo Acuity Test® e StereoTAB® em estudantes do ensino superior

Estereopsia define-se como a perceção de profundidade baseada na disparidade retiniana. A estereopsia global depende do processamento de estímulos de pontos aleatórios e a estereopsia local depende da perceção de contornos. O objetivo deste estudo é correlacionar três testes de estereopsia: TNO®, StereoTAB® e Fly Stereo Acuity Test® e verificar a sensibilidade e correlação entre eles, tendo o TNO® como gold standard. Incluíram-se 49 estudantes da Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL) entre os 18 e 26 anos. As variáveis ponto próximo de convergência (ppc), vergências, sintomatologia e correção ótica foram correlacionadas com os três testes. Os valores médios (desvios-padrão) de estereopsia foram: TNO® = 87,04’’ ±84,09’’; FlyTest® = 38,18’’ ±34,59’’; StereoTAB® = 124,89’’ ±137,38’’. Coeficiente de determinação: TNO® e StereoTAB® com R2=0,6 e TNO® e FlyTest® com R2=0,2. O coeficiente de correlação de Pearson mostra uma correlação positiva de entre o TNO® e o StereoTAB® (r=0,784 com α=0,01). O coeficiente de associação de Phi mostrou uma relação positiva forte entre o TNO® e StereoTAB® (Φ=0,848 com α=0,01). Na curva ROC, o StereoTAB® possui uma área sob a curva maior que o FlyTest®, apresentando valor de sensibilidade de 92,3% para uma especificidade de 94,4%, tornando-o num teste sensível e com bom poder discriminativo.